(Loco)Regionale Technieken

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Classic Block Techniques



Spinal and Epidural Block

Ultrasound scanning (US) can offer several advantages when used to guide placement of the needle for centroneuraxial blocks (CNBs). It is noninvasive, safe, simple to use, can be performed expeditiously, provides real-time images, is devoid from adverse effects, and it may be beneficial in patients with abnormal or variant spinal anatomy.
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Spinal Anesthesia

The three membranes that protect the spinal cord are the dura mater, arachnoid mater, and pia mater. The dura mater, or tough mother, is the outermost layer. The dural sac extends to the second sacral vertebra (S2). The arachnoid mater is the middle layer, and the subdural space lies between the dural mater and arachnoid mater. The arachnoid mater, or cobweb mother, also ends at S2, like the dural sac. The pia mater, or soft mother, clings to the surface of the spinal cord and ends in the filum terminale, which helps to hold the spinal cord to the sacrum. The space between the arachnoid and pia mater is known as the subarachnoid space, and spinal nerves run in this space, as does CSF. 
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Spinal Anesthesia Continued

The pharmacodynamics of spinal injection of local anesthesia are wide-ranging. The next section reviews the cardiovascular, respiratory, and gastrointestinal consequences of spinal anesthesia. This portion of the chapter focuses on the hepatic and renal effects of spinal anesthesia.
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Caudal Anesthesia

The sacral canal is formedby the sacral vertebral foramina and is triangular in shape. It is a continuation of the lumbar spinal canal. Each lateral wall presents four intervertebral foramina, through which the canal is contiguous with the pelvic and dorsal sacral foramina. The posterior sacral foramina are smaller than their anterior counterparts. The sacral canal contains the cauda equina (including the filum terminale) and the spinal meninges
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Caudal Anesthesia Continued

The sacral canal shares in the general engorgement of extradural veins that occurs in late pregnancy, or in any clinical condition in which the inferior vena cava (IVC) is partially obstructed. Since the effective volume of the caudal canal is markedly diminished during the latter part of pregnancy, the caudal dosage should be reduced proportionately in women at term. 
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Thoracic Paravertebral Block

Thoracic paravertebral block (PVB) is a well-established technique for perioperative analgesia in patients having thoracic, chest wall, or breast surgery or for pain management with rib fractures. Ultrasound guidance can be used to help identify the paravertebral space (PVS) and needle placement, and to monitor the spread of the local anesthetic. 
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Thoraco Lumbar Paravertebral Block

A paravertebral block is an advanced nerve block technique. Although in principle, the technique is similar to that of the thoracic paravertebral block, its anatomy and indications are sufficiently distinct to deserve separate consideration. It is paradoxical that this technique is one of the easiest and most time efficient to perform, yet it is one of the most difficult to teach. 
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Intercostal Block

Intercostal block produces discrete bandlike segmental anesthesia in the chosen levels. Intercostal block is an excellent analgesic option for a variety of acute and chronic pain conditions. The beneficial effect of intercostal blockade on respiratory function following thoracic or upper abdominal surgery, or following chest wall trauma, is well documented.
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Lumbar Plexus Block

The lumbar plexus block (psoas compartment block) is an advanced nerve block technique. Because the placement of the needle is in the deep muscles, the potential for systemic toxicity is greater than it is with more superficial techniques. The proximity of the lumbar nerve roots to the epidural space also carries a risk of epidural spread of the local anesthetic. 
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Ilioinguinal and Iliohypogastric Block

Both the iliohypogastric and ilioinguinal nerves emanate from the first lumbar spinal root. Superomedial to the anterior superior iliac spine, the iliohypogastric and ilioinguinal nerves pierce the transversus abdominus to lie between it and the internal oblique muscles. 
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Saphenous Nerve Block

The saphenous nerve is the terminal sensory branch of the femoral nerve. It supplies innervation to the medial aspect of the leg down to the ankle and foot. Blockade of the nerve can be sufficient for superficial procedures in this area; however, it is most useful as a supplement to a sciatic block for foot and ankle procedures that involve the superficial structures in medial territory. 
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Ankle Block

An ankle block is essentially a block of four terminal branches of the sciatic nerve (deep and superficial peroneal, tibial, and sural) and one cutaneous branch of the femoral nerve (saphenous). Ankle block is simple to perform, essentially devoid of systemic complications, and highly effective for a wide variety of procedures on the foot and toes.
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Wrist Block

A wrist block consists of anesthetizing the terminal branches of the ulnar, median, and radial nerves at the level of the wrist. It is an infiltration technique that is simple to perform, essentially devoid of systemic complications, and highly effective for a variety of procedures on the hand and fingers.
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Digital Nerve Block

A digital block is the technique of blocking the nerves of the digits to achieve anesthesia of the finger(s). This technique is simple to perform and essentially devoid of systemic complications. It is a commonly used and effective method of anesthesia for a wide variety of minor surgical procedures on the digits.
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Overzicht van (loco)regionale technieken



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