Anaesthesia

Synonym(s)

Nerve block

Definition
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Form of local anaesthesia: Anaesthesia of a limb or area of tissue by injecting the local anaesthetic directly into the nerve trunk of the anatomically associated nerve or in its vicinity.

Implementation
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Finger block according to Oberst: Distal of the basic joint in each quadrant near the tendons 1-2 ml LA each, onset of action after 5 minutes at the latest. Advantage: Extension of the operation (e.g. small flap plastic) possible.
Cave! No adrenalin supplement (danger of necrosis)! Aspiration test! Strict sterility!
Hand block:

N. medianus (D I-III/IV palmar side and entire terminal limb): M. flexor carpi radialis and palmaris longus medially, approx. 0.5-1 cm deep, after triggering paresthesia. Between tendons and after a negative aspiration test injection of 2-3 ml adrenalin-free LA.
N. radialis (radial back of the hand and dorsal sides D I-III): Subcutaneous infiltration of 3-4 ml LA arched around Proc. styloideus radii.
N. ulnaris (D IV-V): puncture site, preferably with hyperextended wrist, between flexor carpi ulnaris (pulling towards the os pisiforme) and palpable A. ulnaris at a depth of 1-2 cm. 2-3 ml adrenalin-free LA; injection after triggering paresthesia in the little finger and negative aspiration test.

Regional anaesthesia in the face (treatment through branches of the trigeminal nerve I-III): Leading structures for the localisation of the mental and infraorbital nerves: each at the level of the 4th tooth or on a vertical line through the pupil, infiltration as close to the bone as possible, little trauma when injecting intraorally!
Anaesthesia of the penis root: 1 ml lateral to the dorsal penis at the dorsal root, additional infiltration anaesthesia on the opposite side, if necessary up to the frenulum.
Foot block:

Medial edge of the foot, heel and plantar: branches of the saphenous nerve (runs ventral to the inner ankle): 3-4 transverse fingers above the ankle are squared in a ring shape. Tibial nerve (runs dorsally of the inner ankle): Inject 6-8 ml LA around the tibial nerve.
Lateral edge of the foot and heel: sural nerve (dorsal to the external ankle): inject 6-8 ml LA around 3-4 transverse fingers above the ankle between the external ankle and the Achilles tendon.
Back of the foot: N. peronaeus superficialis: Proximal blockade above the ankle lateral to the tibia and additionally distal blockade on the back of the foot annularly at the level of the A. dorsalis pedis (3-4 ml LA each).
Inter toe space DI-II: N. peronaeus profundus: Injection into the inter toe fold from dorsal.