(Loco)Regionale Technieken

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Nerve Stimulator Techniques



Cervical Plexus Block

Cervical plexus block can be performed using two different methods. One is a deep cervical plexus block, which is essentially a paravertebral block of the C2-4 spinal nerves (roots) as they emerge from the foramina of their respective vertebrae. The other method is a superficial cervical plexus block, which is a subcutaneous blockade of the distinct nerves of the anterolateral neck. The most common clinical uses for this block are carotid endarterectomy and excision of cervical lymph nodes. 
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Interscalene Brachial Plexus Block

An interscalene block relies on the spread of a relatively large volume of local anesthetic within the interscalene groove to accomplish blockade of the brachial plexus. In our practice, we almost always use a low interscalene block technique, which consists of inserting the needle more caudally than in the commonly described procedure performed at the level of the cricoid cartilage. 
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Supraclavicular Brachial Plexus Block

he supraclavicular block is often called the “spinal anesthesia of the upper extremity” because of its ubiquitous application for upper extremity surgery. The reasons for its high success rate are in its anatomic characteristics. The block is performed at the level of the distal trunks and origin of the divisions, where the brachial plexus is confined to its smallest surface area 
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Infraclavicular Brachial Plexus Block

he infraclavicular block is performed below the clavicle, where the axillary vessels and the cords of the brachial plexus lie deep to the pectoralis muscles, just inferior and slightly medial to the coracoid process. The boundaries of the space are the pectoralis minor and major muscles anteriorly, ribs medially, clavicle and the coracoid process superiorly, and humerus laterally. 
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Axillary Brachial Plexus Block

The axillary brachial plexus block is one of the most commonly used regional anesthesia techniques. The proximity of the terminal nerves of the brachial plexus to the axillary artery makes identification of the landmarks consistent (axillary artery) equally for both the nerve stimulator and surface based ultrasound-guided techniques. The axillary block is an excellent choice of anesthesia technique for elbow, forearm, and hand surgery.
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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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Cutaneuos Nerve Blocks of the Upper Extremity

Cutaneous nerve blockade is achieved by the injection of local anesthetic into the subcutaneous layers above the muscle fascia. The subcutaneous tissue contains a variable amount of fat, superficial nerves, and vessels. Deeper, there is a tough membranous layer, the deep fascia of the upper extremity, which encloses the muscles of the arm and fore- arm. 
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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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Sciatic Nerve Block: Transgluteal (Posterior)/Anterior Approach

A sciatic nerve block results in anesthesia of the skin of the posterior aspect of the thigh, hamstring, and biceps femoris muscles; part of the hip and knee joint; and the entire leg below the knee with the exception of the skin of the medial aspect of the lower leg
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Popliteal Sciatic Nerve Blocks: Intertendineous (Posteriour) / Lateral Approach

The popliteal block is a block of the sciatic nerve at the level of the popliteal fossa. This block is one of the most useful blocks in our practice. Common indications include corrective foot surgery, foot debridement, and Achilles tendon repair. A sound knowledge of the principles of nerve stimulation and the anatomic characteristics of the connective tissue sheaths of the sciatic nerve in the popliteal fossa are essential for its successful implementation.
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Femoral Nerve Block

A femoral nerve block is a quintessential nerve block technique that is easy to master, carries a low risk of complications, and has significant clinical application for surgical anesthesia and postoperative pain management. The femoral block is well-suited for surgery on the anterior thigh and knee, quadriceps tendon repair, and postoperative pain management after femur and knee surgery.
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Obturator Nerve Block

Obturator nerve block is used to treat hip joint pain and in the relief of adductor muscle spasm associated with hemi-or paraplegia. Muscle spasticity is relatively common problem among patients suffering from central neurological problems such as cerebrovascular pathology, medullar injuries, multiple sclerosis, infantile cerebral palsy, etc. Spasticity of the adductor muscle induced via the obturator nerve, plays a major role in associated pain problems and makes patient grooming and mobilization very difficult.
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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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Ilioinguinal and Iliohypogastric Blocks

Using the anatomic knowledge previously described, one needs to provide a method of block that allows accurate placement of local anesthetic both between the transversus abdominus and internal oblique muscles as well as between the internal oblique and external oblique muscles. Methods of local anesthetic administration that do not accurately define placement between these muscular layers provide inconsistent anesthesia and analgesia of the abdominal wall and inguinal region. 
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Overzicht van (loco)regionale technieken



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