Skip to Main Content


  • Image not available.The greatest immediate risk of nerve blocks is systemic toxicity from inadvertent intravascular injection. Delayed toxicity can follow the initial injection when rapid or excessive amounts of local anesthetics are absorbed systemically.
  • Image not available.Good surgical anesthesia is obtained only when local anesthetic is injected in close proximity to the nerve or nerves that are to be blocked.
  • Image not available.A perineural injection may produce a brief accentuation of the paresthesia, whereas an intraneural injection produces an intense, searing pain that serves as a warning to immediately terminate the injection and reposition the needle.
  • Image not available.Surgical anesthesia of the upper extremity and shoulder can be obtained following neural blockade of the brachial plexus (C5–T1) or its terminal branches at several sites.
  • Image not available.The interscalene approach is most optimal for procedures on the shoulder, arm, and forearm. Injection at the interscalene level tends to produce a block that is most intense at the C5–C7 dermatomes and least intense in the C8–T1 dermatomes.
  • Image not available.The axillary approach to the brachial plexus is most optimal for procedures from the elbow to the hand. This approach tends to produce the most intense block in the distribution of C7–T1 (ulnar nerve).
  • Image not available.Infraclavicular blocks provide good homogeneous anesthesia to the brachial plexus and can be used for procedures involving the hand, forearm, elbow, and upper arm and are quite conducive for placement of an indwelling catheter for postoperative analgesia.
  • Image not available.Intravenous regional anesthesia, also called a Bier block, can provide intense surgical anesthesia for short surgical procedures (< 45–60 min) on the forearm, hand, and even the leg.
  • Image not available.A femoral nerve block is very useful in numerous procedures involving the thigh and knee, such as skin grafting, knee arthroscopy, and patellar surgery, or as an adjunct to procedures distal to the knee that require anesthesia to the medial aspect of the lower leg (saphenous distribution).
  • Image not available.There has been a recent surge of interest in fascia iliaca blocks. Because it does not require a nerve stimulator, it can be performed very quickly, it is not very stimulating, and patients often do not require sedation. It is useful in procedures involving the hip, thigh, and knee.
  • Image not available.Blockade of the sciatic nerve is useful for many surgical procedures involving the hip, knee, or distal lower extremity. The nerve can be successfully blocked at numerous sites along its course.
  • Image not available.A popliteal nerve block is very useful for foot and ankle surgery and can result in complete anesthesia of the limb distal to the knee if a separate saphenous nerve block (terminal nerve of the femoral nerve) is also included.
  • Image not available.Paravertebral nerve blocks are being increasingly used as an effective technique for postoperative analgesia following mastectomy, inguinal hernia repair, and several procedures involving the chest and body wall.


Advancement in needle delivery devices, safer local anesthetics, and development of indwelling catheters for postoperative perineural infusion have led to a transformation in regional anesthesia; the focus has shifted from providing intraoperative regional anesthesia to providing intraoperative anesthesia and postoperative regional analgesia.


Fundamental to the success of regional anesthesia is the ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.