Lower Extremity- Peripheral Nerve Blocks

peripheral nerve block
injection of a LA around a nerve or group of nerves with blockade of nerve impulse conduction, causing temporary analgesia and loss of SENSORY AND MOTORO FUNCTION. (not necessarily both)
Benefits of PNBs
improved analgesia
decreased need for narcotics
decreased PACU/hospital stay
decreased PONV
improved blood flow to extremity
improved function recovery
patient satisfaction
improved cognitive recovery
PNBs directly decrease:
PONV
ileus
resp depression
hypotension
bradycardia
lethargy
confusion/delirium
allergic reactions
contraindications
patient refusal
patient’s cognitive function
infection/burn at injection site
exisiting neryologic injury
LA allergy
vascular grafts
coagulopathy
choice of LA
consider: duration, onset, toxicity profile, cost, site

usually lidocaine or bupivicaine

epinephrine
increases duration
local vasoconstriction, decreased vascular uptake
improved quality (d/t alpha 2 agonism)
decreased LA blood conc.

concerns: worsening neurologic injury, systemic absorption (HOTN/tachycardia)

Pre-op neurologic injury
MECHANICAL damage to nerve
HEMATOMA formation
intra-op
surgical injury
positioning
tourniquet injury
ISCHEMIA
COMPRESSION
post-op
PRESSURE injury from positioning
COMPRESSION (cast)
ischemia (loss of blood flow)
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