short axis view" so the
nerve shows up as a
circle and I can identi-
fy all of the appropri-
ate surrounding anato-
my and make note of
all of the vessels. Then
I insert my needle "in
plane," which looks
like a needle in this
view. I use the nerve
stimulator to make the
nerve twitch to verify I'm looking at the correct one. Then I adminis-
ter the anesthetic and watch it pool around the nerve. Once the single
shot block is complete, I thread the catheter all while looking on the
ultrasound screen. It may seem like a lot of steps but once you get
into a routine it makes the blocks go much smoother and quicker.
Quick note: Not all nerve blocks actually have a nerve that can be
stimulated as with transversus abdominis plane (TAP) blocks. Nerves
can come in 2 flavors: those that are sensory only and those that are
mixed motor and sensory. Nerve stimulators can only make mixed
nerves twitch.
4. Manometer
Another device you can add to your arsenal is a manometer or a pres-
sure regulator. Place a manometer between the syringe and the injec-
tion tubing of the needle so you can quantify and monitor the injec-
tion pressure exiting the needle. We're constantly using smaller and
smaller needles to try to make our patients comfortable, but if you
decrease the diameter of the needle and try to force the same amount
M A Y 2 0 1 8 • O U T PA T I E N TS U R G E R Y. N E T • 7 3
• SEE THE BLOCK Ultrasound guidance is a must have to see the blood vessels
surrounding the nerves you're trying to block.
