Block It Like It’s Hot: Regional Anesthesia, Pain Medicine & POCUS S2:E2 "Forearmed is Forewarned: Nerve blocks for median, ulnar, radial and other distal nerves of the upper limb"
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Mar 15, 2024 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.
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Self-Performed Tibial Nerve Block Relieved Severe Pain
- Jeff performed a tibial nerve block at home for acute plantar fascia pain and went from severe pain to zero within minutes.
- He used bupivacaine via landmark technique without ultrasound and had immediate analgesia that lasted long enough to sleep.
Short-Acting Spinal Sometimes Requires Conversion
- Amit recounted two difficult spinals in one day and a failed short-acting spinal that required conversion to general anesthesia after two hours.
- He reflected that short-acting spinals carry calculated risk and timing matters when surgeons run two rooms.
Unexpected Anatomy Caused Infra‑Clavicular Failure
- Amit described an infra-clavicular block that provided no effect until a small axillary block made the hand anesthetic for only an hour.
- He found unusual anatomy: duplicated median components and a split lateral cord likely explaining the infra-clavicular failure.