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Chapter 11a - Regional Anesthesia: Blocks of the Upper and Lower Extremities

Published online by Cambridge University Press:  24 May 2023

Alan David Kaye
Affiliation:
Louisiana State University School of Medicine
Richard D. Urman
Affiliation:
Brigham and Women’s Hospital, Boston
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Summary

A regional block, also known as a localized block, is a type of anesthetic that blocks nerve transmission to prevent or alleviate pain. Regional anesthesia is the process of injecting an anesthetic substance into a peripheral nerve and inhibiting transmission to avoid or treat pain. It is distinct from general anesthesia in that it does not alter the patient’s level of awareness to alleviate pain. There are numerous advantages of regional anesthesia over general anesthesia, including avoidance of airway manipulation, lower dosages, fewer systemic medication adverse effects, shorter recovery period, and considerably less discomfort following surgery.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Further Reading

Baker, JF, et al. Post-operative opiate requirements after hip arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2011;19:1399–402.CrossRefGoogle ScholarPubMed
Birnbaum, K, Prescher, A, Hessler, S, Heller, KD. The sensory innervation of the hip joint – an anatomical study. Surg Radiol Anat. 1997;19:371–5.CrossRefGoogle ScholarPubMed
Bruhn, J, van Geffen, GJ, Gielen, MJ, Scheffer, GJ. Visualization of the course of the sciatic nerve in adult volunteers by ultrasonography. Acta Anaesthesiol Scand. 2008;52:1298–302.CrossRefGoogle ScholarPubMed
Burckett-St Laurant, D, et al. The nerves of the adductor canal and the innervation of the knee: an anatomic study. Reg Anesth Pain Med. 2016;41(3):321–7.CrossRefGoogle ScholarPubMed
Chan, VW, Nova, H, Abbas, S, McCartney, CJ, Perlas, A, Xu, DQ. Ultrasound examination and localization of the sciatic nerve: a volunteer study. Anesthesiology. 2006;104:309e14.CrossRefGoogle ScholarPubMed
Feigl, GC, Schmid, M, Zahn, PK, Gonzalez, CA, Litz, RJ. The posterior femoral cutaneous nerve contributes significantly to the sensory innervation of the lower leg: an anatomical investigation. Br J Anaesth. 2020;124:308e13.CrossRefGoogle Scholar
Gerhardt, M, et al. Characterization and classification of the neural anatomy in the human hip joint. Hip Int. 2012;22:7581.Google Scholar
Giron-Arango, L, et al. Pericapsular nerve group (PENG) block for hip fracture. Reg Anesth Pain Med. 2018;43:859–63.Google ScholarPubMed
Haslam, L, et al. Survey of current practices: peripheral nerve block utilization by ED physicians for treatment of pain in the hip fracture patient population. Can Geriatr J. 2013;16(1):1621.CrossRefGoogle ScholarPubMed
Horner, G, Dellon, AL. Innervation of the human knee joint and implications for surgery. Clin Orthop Relat Res. 1994;301:221–6.Google Scholar
Johnson, CS, Johnston, RL, Niessen, AD, Stoike, DE, Pawlina, W. Ultrasound-guided posterior femoral cutaneous nerve block: a cadaveric study. J Ultrasound Med. 2018;37:897903.CrossRefGoogle ScholarPubMed
Karmakar, MK, Kwok, WH, Ho, AM, Tsang, K, Chui, PT, Gin, T. Ultrasound-guided sciatic nerve block: description of a new approach at the subgluteal space. Br J Anaesth. 2007;98:390e5.CrossRefGoogle ScholarPubMed
Kaye, AD, Urman, RD, Vadivelu, N, eds. Essentials of Regional Anesthesia, 2nd ed. Cham: Springer; 2018.Google Scholar
Kuang, MJ, et al. Is adductor canal block better than femoral nerve block in primary total knee arthroplasty? A GRADE analysis of the evidence through a systematic review and meta-analysis. J Arthroplasty. 2017;32(10):3238–48.e3.CrossRefGoogle ScholarPubMed
Lenz, K, et al. Comparing low volume saphenous-obturator block with placebo and femoral-obturator block for anterior cruciate ligament reconstruction. Minerva Anestesiol. 2018;84(2):168–77.Google Scholar
Li, J, et al. Novel regional anesthesia for outpatient surgery. Curr Pain Headache Rep. 2019;23:69.CrossRefGoogle ScholarPubMed
Mansour, NY. Re-evaluating the sciatic nerve blocks: another landmark for consideration. Reg Anesth. 1993;18:322e3.Google Scholar
Runge, C, et al. The analgesic effect of obturator nerve block added to a femoral triangle block after total knee arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2016;41(4):445–51.CrossRefGoogle ScholarPubMed
Sharma, S, et al. Complications of femoral nerve block for total knee arthroplasty. Clin Orthop Relat Res. 2010;486:135–40.Google Scholar
Shelvin, S, Johnston, D, Turbitt, L. The sciatic nerve block. Br J Anaesth. 2020;20(9):312–20.Google Scholar
Short, AJ, et al. Anatomic study of innervation of the anterior hip capsule: implications for image-guided intervention. Reg Anesth Pain Med. 2018;43:186–92.Google ScholarPubMed
Sinha, SK, et al. Ultrasound-guided obturator nerve block: an interfascial injection approach without nerve stimulation. Reg Anesth Pain Med. 2009;34(3):261–4.CrossRefGoogle Scholar
Sinha, SK, et al. Use of ultrasound guided popliteal fossa infiltration to control pain after total knee arthroplasty: a prospective, randomized, observer-blinded study. American Society of Regional Anesthesia and Pain Medicine, Spring Meeting. San Diego, CA; 2012, Poster A51.Google Scholar
Sinha, SK, et al. Infiltration between the popliteal artery and capsule of the knee (iPACK): essential anatomy, technique, and literature review. Curr Anesthesiol Rep. 2019;9:474–8.CrossRefGoogle Scholar
Sinha, SK. How I do it: infiltration between popliteal artery and capsule of knee (iPACK). ASRA News. 2020. Available from: www.asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2020/05/03/how-i-do-it-infiltration-between-popliteal-artery-and-capsule-of-knee-(ipack).Google Scholar
Smith, JH, et al. Adductor canal versus femoral nerve block after anterior cruciate ligament reconstruction: a systematic review of level I randomized controlled trials comparing early postoperative pain, opioid requirements, and quadriceps strength. Arthroscopy. 2020;36(7):1973–80.CrossRefGoogle Scholar
Taha, AM. Brief reports: Ultrasound-guided obturator nerve block: a proximal interfascial technique. Anesth Analg. 2012;114(1):236–9.Google Scholar
Vloka, JD, Hadzic, A, April, E, Thys, DM. The division of the sciatic nerve in the popliteal fossa: anatomical implications for popliteal nerve blockade. Anesth Analg. 2001;92:215e7.CrossRefGoogle ScholarPubMed
Wertheimer, LG. The sensory nerves of hip joint. J Bone Joint Surg Am. 1952;34:477–87.Google Scholar
Xing, JG, et al. Preoperative femoral nerve block for hip arthroscopy: a randomized, triple-masked controlled trial. Am J Sports Med. 2015;43:2680–7.Google Scholar

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