PRAC: Nerve Block

Question 1

What should nerve block sites be scrubbed with?

Answer 1

Chlorhexidine

Question 2

Which anaesthetics can be used for nerve blocking?

Answer 2

Lidocaine: 1-2hrs
Mepivicain: 2-3hrs
Bupivicaine: 3-6hrs

Question 3

What does a palmar/planter digital block? Volume required?

Answer 3

• 70% foot including sole
• most of DIP j
• 2-4ml

Question 4

3 approaches to the DIP j specificaly?

Answer 4

• dorsal midline
• approach later/medial to extensor tendon (not really necessary, will stil go though tendon)
• palmar/plantar approach

Question 5

Approaches to the navicular bursa

Answer 5

> midline navicular position

• horizontal approach
• 30* oblique approach

Question 6

Appraoches to the PIPj?

Answer 6

> dorsal 
- abaxial to extensor tendon
- level of palmar process P1
> palmar/plantar
- V shaped notch
- dorsal:distal palmar P1
- Distal:eminence collateral ligament and proximal P2
- Distal:insertion SDFT

Question 7

What does the low palmar/plantar nerve block?

Answer 7

• metatarsal nerve
• palmar/plantar nerve
  > avoid DFSTS
• dorsal subcutaneous ring block (skin sensation, hindlimbs)

Question 8

What does an abaxial sesamoid block?

Answer 8

• lat and med palmar/plantar digital NVBs (nerves palamr aspect of bundle VAN)

Question 9

What does low 4 point block?

Answer 9

• lat and med PALMAR nn. (between suspensory and DDFT)

- lat and med PALMAR METACARPAL nn. (distal to button of splint)

Question 10

What does low 6 point block?

Answer 10

• lat and med PLANTAR nn.
• lat and med PLANTAR METATARSAL nn.
• DORSAL METATARSAL nn.

Question 11

Where is the PDNB placed?

Answer 11

[palmar digital]

• NVB just proximal to the collateral cartilage of the distal phalanx
• PDN most palamr
• aim distally

Question 12

Where is the ASNB placed?

Answer 12

[abaxial sesamoid]

• palapate NVB at level of base of prox sesamoids
• aim distally

Question 13

Landmarks of low 4 point?

Answer 13

• palmar nerve: between DDFT and SL

- palmar metacarpal n : below level of button of splint

Question 14

Landmarks of DIP joint block?

Answer 14

• midline, 1cm prox coronary band
• aim slightly distal to the perpendicular
• needle should penetrate dorsal pouch of the joint (extends proximally to about the centre of middle phalanx)