with the plan. Sharing knowledge and communicating beforehand is
key to making these interactions less stressful and yielding better
patient results.
11. It's OK to start with your needle up against the probe.
If you start with your needle up against the probe, it doesn't matter how
echogenic your needle is, you won't see it. Proper needle placement is
key to increasing the safety and efficacy of your blocks. Starting with
your needle about the depth of your target in centimeters away from
the probe lets you create an angle of entry to the skin ideal for needle
visualization. Good needle visualization leads to more effective blocks
and more precise catheter placement — it also helps you avoid nerve
injury.
12. It's best not to isolate specific nerves. Not only is it possi-
ble to isolate specific nerves for blocking — in some cases it's ideal.
In our practice, we've found that sometimes isolating specific nerves
cannot only be easier to perform, but can have increased benefits.
For example, isolating the tibial nerve distal to the sciatic nerve split
into peroneal and tibial nerves is a shallower block. This allows for
ease of nerve visualization and with only blocking the tibial nerve
you have the potential to provide pain control to the posterior knee
while avoiding foot drop. Isolating nerves at the terminal branches
of the brachial plexus is a good way to rescue a patient who may not
have a complete upper extremity block in place and is still having
pain in recovery.
13. I don't have to worry about patient positioning when
placing blocks.
Taking the time to properly position your patient
before your block will make your life easier. Position your patient in
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