Forearmed is Forewarned: Bits and Bobs of the Plexus
Mar 15, 2024
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Amit and Jeff discuss nerve blocks in the upper limb, including around the elbow, forearm, and wrist. They share failed block stories, address listener questions about LAST, and somehow bring up Paris Hilton. Also, they touch on challenges of moving to electronic consent forms in medical practices.
Targeted nerve blocks are essential for hand surgeries to balance mobility and anesthesia postoperatively.
Understanding anatomical structures like the arcade of Frosh is crucial for safe and precise nerve block administrations.
Evaluating the risks and benefits of differential nerve blocks is vital to prevent nerve crush phenomena and ensure optimal anesthesia.
Deep dives
Different Approaches to Nerve Blocks for Enhanced Precision
Nerve blocks like the median, ulnar, and radial are strategically used for specific areas of surgery to provide efficient and controlled numbness. These targeted blocks are particularly useful for hand surgeries, ensuring the arm remains mobile postoperatively while the hand is adequately anesthetized. Additionally, differential blocks with short-acting agents proximally followed by longer-acting ones distally offer a balance between quick recovery and extended analgesia, especially for intricate procedures.
Anatomical Terms and Considerations in Nerve Blocks
Exploring anatomical intricacies like the arcade of Frosh and the potential risks of nerve crush phenomena in nerve blocks presents a detailed perspective on nerve block practices. Understanding specific anatomical structures like the arcade of Frosh provides a deeper appreciation of nerve pathways and potential sensory innovations. Moreover, navigating potential risks, such as nerve compression with persistent arteries, broadens the awareness required for precise and safe nerve block administrations.
Challenges and Controversies in Nerve Block Techniques
Addressing controversial aspects like differential nerve blocks and potential nerve crush phenomena raises critical discussions on the complexity of nerve block procedures. The considerations of single, double, or triple crush phenomena highlight the intricate balance required in administering nerve blocks to avoid nerve injury. Evaluating the optimal strategies for nerve anesthesia involves weighing the benefits of precise analgesia against the risks of inadvertent nerve damage due to multiple block points along nerve pathways.
Double Crush Phenomenon and Nerve Blocks
The episode delves into the concept of the double crush phenomenon within peripheral nerves, where subclinical injuries along a nerve's path can lead to clinical symptoms when compounded by subsequent injuries. It touches on various causes like mechanical, chemical, and metabolic factors. The discussion also addresses the concern around nerve blocks causing long-lasting nerve injuries, highlighting that while nerve blocks can lead to nerve injury in certain cases, the risk of severe impacts is relatively low.
Wide Awake Local Anesthetic Technique
The podcast presents the controversial topic of the wide awake local anesthetic no tourniquet technique for surgical anesthesia without intubation. This method involves diluting a large volume of local anesthetic with hyaluronic acid and adrenaline to provide surgical anesthesia while preserving motor function. The hosts discuss its application during COVID for trauma cases when anesthetists were occupied, sharing experiences and considerations regarding its effectiveness and potential outcomes. They debate the benefits of traditional nerve blocks versus this technique, emphasizing the importance of precise nerve block placement for consistent results.
Amit and Jeff continue their tour of the upper limb, focusing on blocking the distal branches around the elbow, forearm and wrist. Also in this episode: discussion of listener questions about LAST, sharing of failed block stories, and somehow, weirdly, a reference to Paris Hilton.
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