2. 2 categories of anaesthesia; general and
regional.
– General anaesthesia: to induce analgesia,
sedation, amnesia, suppression of autonomic
reflexes and relaxation of muscles
– Regional anaesthesia: site specific
3. Mechanism
• decrease transduction of pain
• interfere with nerve conduction to provide a
reversible loss of sensation in a specific
location
–affects the depolarization phase of action
potentials (cells fail to depolarize enough to
fire after excitation leading to a blocked
action potential)
5. Finger block
• Necessary to provide complete anaesthesia
when treating most fingertip injury.
• Indications:
– Nail bed injuries
– Nail avulsions
– Foreign bodies of the digit
6. • Anatomy of hand consist of four nerve
supplying each finger. Two run on the volar
aspect of each finger and dorsal in location
and sensory distribution.
7.
8. • Procedure:
– Needle is position into the proximal region of the web
space, as closed as possible to the phalanx
– Needle is advanced anteriorly until skin on the palmar
surface begins to tent, whereupon the needle is
retracted slightly.
– Same protocol is repeated to block the corresponding
two nerves on the opposite side of the finger.
• Not to use vasoconstrictor (epinephrine), as it can
compromise blood flow to the digit.
9. Wrist block
• A technique for blocking branches of ulnar,
medial and radial nerves at level of wrist
• It is simple to perform and devoid of systemic
complications and highly effective for variety
of procedures on hand and fingers.
• Indications:
– Carpal tunnel and hand surgery
– Finger surgery
10.
11. • Radial nerve:
– Locate radial styloid
– Inject just medial and behind radial styloid (lateral
to brachoradialis)
– Give both subcutaneous and deep
• Median nerve:
– Flex thumb, locate Flexor policis longus & flexor
carpi radialis
– Inject in between
– Insert needle until deep fascia (contact bone).
12. • Ulnar nerve:
– Flex wrist and locate flexor carpi ulnaris and
medial to ulnar artery.
– Inject posterior to it (deep)
– Advise to inject above FCU subcutaneously (to
block subcutaneous branches)
13. Ankle block
• Complete nerve block of foot requires
blocking 3 superficial nerves (sural, saphenous
and superficial peroneal) and 2 deep nerves
(posterior tibial and deep peroneal)
14. • Posterior tibial nerve:
– Locate medial malleolus
– Palpate posterior tibial artery
– Inject 1cm superior and behind medial malleolus
– Cover sole of foot
• Sural nerve
– From behind lateral malleolus to archilles tendons
• Superficial peroneal nerve
– Palpate extensor hallucis logus tendon and lateral
malleolus
– Inject between tendon and malleolus
15. • Deep peroneal nerve
– Locate extensor hallucis longus tendon (while
dorsiflex foot and big toe)
– Lateral to it
– Inject until it strikes bone beneath
• Saphenous nerve
– Medial malleoulus to Archilles tendon
