Contents

Brachial plexus Block

I. Interscalene Block 2
II. Supraclavicular Block 6
III. Axillary Block
6

Peripheral Nerve Blocks at the Elbow

I. Ulnar Nerve
8

II. Median Nerve

1
0
III. Radial Nerve
1
2
Peripheral Nerve Blocks at the Wrist
I. Ulnar Nerve
1
4
II. Median Nerve 16
III. Radial Nerve 18
Sciatic Nerve Block
I. Posterior Sciatic Nerve Block 20
II. Anterior Sciatic Nerve Block 22
3 in 1-Block 24
Peripheral Nerve Blocks about the Knee
I. Peroneal Nerve 26
II. Tibial Nerve 28
III. Saphenous Nerve 30
Foot Block 32
I. Interscalene
Block

Indications:
Operations on clavicle, shoulder, upperarm, hand and reductions of
the shoulder joint
Special Contraindications:
Contralateral phrenic paralysis and contralateral recurrent
laryngeal n. paralysis
Side-effects:
Horner's syndrome, phrenic block, recurrent laryngeal n. block
Complications:
Total spinal anesthesia, high epidural anesthesia
Landmarks:
Sternomastoid m1., interscalene groove3, cricoid5
Puncture site:
In the interscalene groove, at the level of the cricoid
Insertion of needle:
Medial, caudal (in an angle of 30e to the sagittal plane) and slightly
dorsal, directed to the transverse process of C 6
Dosage:
30-40 ml 1% lignccaine or prilocaine (duration 3 h) or 0,375%
bupivacaine ( 1 0 h)
 II. Supraclavicular
Block

Indications:
Operations of upper arm, lower arm and hand
Special Contraindications:
Hamorrhagic diathesis, contralateral phrenic paralysis,
contralateral recurrent n. paralysis, contralateral pneumothorax
Side-effects:
Horner's syndrome, phrenic n. block, recurrent laryngeal n. block
Complications:
Pneumothorax, puncture of the subclavian a.
 Landmarks:
Clavicle1, subclavian a.2
Puncture site:
Immediate dorsolateral from the palpated pulsation of the subcla vian
a.
Insertion of needle:
Caudal direction and slightly lateral, parallel to the scalene muscles
Dosage:
40 ml 1% prilocaine or 40 ml 0,375% bupivacaine
III. Axillary Block

Indications:
Operation on lower arm and hand
Special Contraindications:
Lymphangitis
Complications:
Puncture of the axillary a.

Landmarks:
Pulsation of the axillary a. in the axillary groove between the
pectoralis major m. and the latissimus dorsi m.
Puncture site:
Immediately above the axillary a., as proximal as possible
Insertion of needle:
Adjacent to axillary a. to enter the perivascular sheath
Dosage:
40 ml 1% lignocaine or prilocaine or 0,375% bupivacaine
Peripheral Nerve
Blocks at the Elbow

I. Ulnar Nerve

Indications:
Diagnostic, therapeutic and operative interventions in the area of
innervation, completion of incomplete brachial plexus block.
Special Contraindications:
none
Landmarks:
Medial epicondyle of humerus1, olecranon2
Puncture site:
1-2 cm proximal from the palpated ulnar nerve in the ulnar groove3
Insertion of needle:
Introduce the needle in direction to the longitudinal axis of humerus
1 - 2 cm deep
Dosage:
2-5 ml 1% prilocaine or 0,5% bupivacaine
II. Median Nerve

Indications:
Diagnostic, therapeutic and operative interventions in the area of
innervation, completion of incomplete brachial plexus block
Special Contraindications:
none
Landmarks:
Medial and lateral epicondyles of humerus
Puncture site3:
Immediately medial to the brachial a2.
Insertion of needle:
Introduce the cannula 5 mm deep
Dosage:
5 ml 1 % lignocaine or prilocaine or 0,5% bupivacaine
III. Radial Nerve

Indications:
Diagnostic, therapeutic and operative interventions in the area of
innervation, completion of incomplete brachial plexus block
Special Contraindications:
none
Landmarks:
Medial epicondyle of humerus, brachioradialis m., biceps tendon
Puncture site2:
In the cleft1 between the brachioradialis m. and the biceps tendon at
the level of elbow joint
Insertion of needle:
Push the needle in a proximal and lateral direction to the lateral
margin of lateral epicondyle of humerus. When bone contacted,
infiltrate 2-4 ml local anaesthetic: then advance in a cranial
direction about 1-3 cm in the longitudinal axis of the humerus,
contact the bone again and retract the needle 2-5 mm.
Dosage:
1 0 - 1 5 ml 1% lignocaine or prilocaine or 0,5% bupivacaine
Peripheral Nerve
Blocks at the Wrist
I. Ulnar Nerve

Indications:
In combination with median nerve block and radial nerve block, all
operations on the hand
Special Contraindications:
none
Landmarks:
Flexor carpi ulnaris tendon2.Palmaris longus tendon3
Puncture site4:
Directly lateral to the flexor carpi ulnaris tendon
Insertion of needle:
Introduce the cannula vertical to the skin 0.5-1 cm deep (if there is a
strong resistance to injection, retract 2 mm)
Dosage:
2 ml 1 % lignocaine or prilocaine or 0,5% bupivacaine
II. Median Nerve

Indications:
In combination with ulnar
nerve block and radial nerve
block, all operations on the
Hand

Special Contraindications:
none
Landmarks:
Palmaris longus tendon1
Puncture site3:
Directly lateral to the palmaris longus tendon
Insertion of needle:
Introduce the cannula vertical to the skin 0,5-1 cm deep (if there is a
strong resistance to injection, retract 2 mm)
Dosage:
2 ml 1 % lignocaine or prilocaine or 0,5% bupivacaine
 I. Radial Nerve

Indications:
In combination with ulnar nerve block and median nerve block, all
operations on the hand Special Contraindications: none

Landmarks:
Pulsation of the radial a.1
Puncture site2:
About 1 cm lateral to the pulsation of the radial a.
Insertion of needle:
Parallel to the wrist subcutaneously
Dosage:
5 ml 1% lignocaine or prilocaine or 0,25% bupivacaine
 Sciatic Nerve
Block

I. Posterior Sciatic Nerve Block

Indications:
In combination with the 3 in 1-block, all operations on the lower limb
Special Contraindications: none
Landmarks::
Posterior superior iliac spine1, greater trochanter2
Puncture site:
3 cm below middle of line joining 1 & 2
Insertion of needle:
Introduce the needle vertical to the skin 6-8 cm deep
Dosage:
20-30 ml 1 % lignocaine or prilocaine or 0,5% bupivacaine
//. Anterior Sciatic Nerve Block

Landmarks:
Inguinal ligament1, greater trochanter2
Puncture site:
At the point of intersection of a line from the junction of the middle
third and the medial third of the inguinal ligament with a line parallel to
the inguinal ligament at the greater trochanter level
Insertion of Needle:
Slight lateral direction to contact the femur, retract the needle to the
subcutaneous area and correct the direction until the needle slides
off the femur, then push forward approx. 5 mm
Dosage:
10-20 ml 1% lignocaine or prilocaine or 0,5% bupivacaine
3 in 1-block

The lumbar plexus is "sandwiched" (Winnie) between the psoas major m. and the quad-
ratus lumborum m. and enveloped by their sheaths

Local anaesthetic runs up from the injection site and blocks the femoral n., the lat. cut. n. of
thigh and the obturator n.

Indications:
In combination with sciatic nerve block, all operations on the lower
limb
Special Contraindications:
none
Landmarks:
Inguinal ligament2, femoral a.1
Puncture site:
Below the inguinal ligament, 1-1,5 cm lateral from the femoral a.
Insertion of Needle:
In slightly cranial direction
Dosage:
25—30 ml 1 % lignocaine or prilocaine or 0,5% bupivacaine
Peripheral
Nerve Blocks
at the Knee
I. Common
peroneal
nerve

Indications:
Completion of incomplete peridural anaesthesia or sciatic nerve
block, diagnostic, therapeutic and operative interventions in the
area of innervation, especially fractures of the lateral part of the
ankle and ruptures of the lateral ligament.
Special Contraindications:
none
Landmarks:
Head of fibula1, biceps femoris tendon2
Puncture site3:
Immediately posterior to fibula, 2 cm below head
Insertion of needle:
Introduce the needle vertical to the skin approx. 1 cm deep
Dosage:
5 ml 1 % lignocaine or prilocaine or 0,5% bupivacaine
II. Tibial Nerve

Indications:
Completion of incomplete peridural anaesthesia or sciatic nerve
block; in combination with common peroneal and saphenous
nerve block: operations in the area of lower leg and foot
Special Contraindications:
none
Landmarks:
Internal and external epicondyles of femur, medial and lateral gas-
trocnemius m.
Puncture site:
In the middle of the line connecting the lateral and medial epicondyles
of femur.
Insertion of needle:
Introduce the needle vertical to the skin 1,5-3 cm deep
Dosage:
5-10 ml 1% prilocaine or 0,5% bupivacaine
 I. Saphenous Nerve

Indications:
Completion of incomplete femoral nerve block, in combination with
tibial and fibular nerve block: operations of lower leg and foot
Special Contraindications:
none
Landmarks:
Medial condyle of tibia, pes anserinus, tibial tuberosity1, gastro-
cnemius m.
Puncture site:
At the medial part of the tibial tuberosity
Insertion of needle:
S.c. infiltration from the medial part of the tibial tuberosity to the gas-
trocnemius m.
Dosage:
5- 10 ml 1% lignocaine or prilocaine or 0,5% bupivacaine
Foot Block

Indications:
All operations of foot and toes
Special Contraindications:
none
Landmarks:
Medial malleolus1, tibial a.2
Puncture sites:
On both sides of the tibial a.
Insertion of needle:
Introduce the needle vertical to the skin 0,5-2 cm deep
Dosage:
2-3 ml of 1% prilocaine or 0,5% bupivacaine
Landmarks:
Dorsalis pedis a.2
Puncture sites:
On both sides of dorsalis pedis a.
Insertion of needle:
Introduce the needle vertical to the skin directly beside the artery, up to
slightly below it. Repeat on other side of a.
Dosage:
2-3 ml 1 % lignocaine or prilocaine or 0,5% bupivacaine for each
injection
Landmarks:
Lateral malleolus1, tibial edge, achilles tendon
Insertion of needle:
S. c. infiltration from the tibial edge to the achilles tendon about one
hand's breadth above the lateral malleolus ^
S.c. infiltration from the tibial edge to the achilles tendon about one
hand's breadth above the medial malleolus
Dosage:
10-20 ml of 1% prilocaine or 0,25%-0,5% bupivacaine