Nerve blocks under GA

Started by Russell Coupland, January 06, 2005, 02:42:42 AM

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Russell Coupland

I was recently reprimanded (by my resident!) for putting in a femoral nerve block while the patient was asleep. It has been standard practice of mine for many years to do this for femoral shaft fractures, knee surgery etc. I use a nerve stimulator, a short bevel needle and do not inject if there is any resistance at all. In all my years I have never had a problem.

Do others condone this? Are there any blocks that are justified for insertion while under a GA (patient, not practitioner!)?


The only block I do while the patient is under a GA is the fascia iliaca block that I have described on another post. The reasoning is that because we are deliberately avoiding the femoral nerve and aiming for the fascia iliaca space, we are very unlikely to hit the femoral nerve and cause damage.


I've struggled with the same issue, thinking it is more efficient and comfortable for the patient to put the block in while asleep.  After considerable reflection and discussion with my peers, I have gone back to doing the block while the patient is awake.  Even if you see contractions with the nerve stimulator disappear before you hit 0 milliamperes you can not be assured that your needle is not intraneural.  One quadriceps palsy could ruin your whole day   : >(


It is standard to do nerve blocks under general anesthesia in children. This is not the same in adults. These are two different kind of populations. One of the biggest studies in this area was published in Anesth Analg 1996 which was a French prospective study that involved 164 anesthesiologists over 38 institutions and 85 thousand pediatric patients that had general anesthesia. In this study there were 24 thousand blocks. The incidence of complications was very low.

One of the important issues is:  Nerve block in children should be performed by experienced anesthesiologist with training and experience in this area. In this way we keep complications low. It will be good for you to review this study.

Dr.Rengarajan M.D

we generally do nerve blocks under Midazolam sedation.Only in children we do it under GA


Does anyone have sound figures on complication from nerve blocks to contrast the real risk of performonf them awake versus asleep?

I fully understand the rationale for both approaches and personally feel that fore humanitarian reasons it is preferable to perfrom them with the patient asleep if at all possible. 


To importants thinghs: in children always asleep, in adults we perform in most of the cases with the patient talking with us. But I think, no problem if the current is >0.4 mAmp and more importante is the pression in the plunger of seringe


A nerve block decreases your pain during and after surgery.  It is more effective than pain medications through the IV.  Because you have less pain, you will need less oral or IV pain medications, even though you have the medications available to you.  Supplement reviews You will have fewer side effects of pain medications, such as respiratory depression, itching, nausea, and somnolence.  In addition, you may be able to avoid a general anesthesia.   Sometimes, a nerve block is done in addition to a general anesthesia for pain relief after the surgery.