You've Been Blocked!

Case 1

CC:  Laceration to Upper Lip

HPI:  23 year old male presents to the ED with laceration to his upper lip.  Patient states he was “Minding his own business” when all of the sudden the ground came up and hit him in the face.   His friend alcohol might have been there.  Patient states he now has a cut on his lip and a bruise on his pride.

Physical Exam:  Physical exam demonstrates a 2 centimeter full thickness laceration of the left upper lip that crosses the vermillion border.

+ How Would you Anesthetize this Patient?

Infraorbital block

By performing an infraorbital block, you can numb the V2 sensory distribution over the maxilla, upper lip, and incisors with a single injection. Lip repair is a cosmetically sensitive procedure, especially if the laceration involves the vermillion border. Using the infraorbital block will help to prevent any swelling or distortion of the anatomical landmarks that might occur with direct infiltration.

Check out our Head and Mouth Regional Anesthesia page for the procedure video!

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Case 2

CC:  Multiple Lacerations to Hand

HPI:  37 year old female presented to the emergency department with a dog bite injury to her right hand.  She states she was playing with her neighbor’s dog when it made a move for the large 64 oz steak she happened to be carrying in her hand.  The dog ended up biting the ulnar side of her hand, leaving several lacerations on her palm and small finger.

Physical Exam:  Patient has a 3 cm horizontal laceration over the hypothenar eminence, as well as a 2cm laceration on the dorsum of the hand over the metacarpals of the 4th and 5th digit. 

+ How Would you Anesthetize this Patient?

Ulnar Nerve Block

The ulnar nerve distribution covers the medial aspect of both the palmar and dorsal surfaces of the hand. Performing the nerve block should allow you to anesthetize both areas with a single injection.

Check out our Hand and Wrist Regional Anesthesia page for the procedure videos!

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Case 3

CC:  Multiple lacerations to the bottom of bilateral feet

HPI:  Marv, one of the henchmen from the Home Alone Movies, presents to the emergency room after sustaining many injuries at the hands of the MacGyver-like Macaulay Culkin.  Among these injuries are multiple lacerations to the plantar surfaces of both feet after walking on broken glass ornaments.  

Physical Exam:  Patient has several linear lacerations over the plantar surfaces of both feet. 

+ How Would you Anesthetize this Patient?

Posterior Tibial Nerve Block

The posterior tibial nerve, which eventually divides into the medial and lateral plantar nerves, supplies most of the sensory innervation to the plantar surface of the foot. It also encompasses the calcaneal nerve which innervates the heel. By performing the posterior tibial nerve block, you may be able to successfully anesthatize the entire plantar surface of Marv’s foot. This will help to avoid the large number of individual injections that would be required with direct infiltration, which is especially handy in a sensitive area like the plantar surface of the foot.

Check out our Foot and Ankle Regional Anesthesia for the procedure videos!

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Regional anesthesia can provide significant pain relief for a number of injuries, are often better tolerated than local infiltration (especially for injuries on the sole of the foot and palm of the hand), and can aid in the cosmetic repair of facial lacerations.  Drs. Nick Ludmer, Dr. Aalap Shah, and Dr. Jeff Hill have created interactive graphics to help you perform these simple procedures.  Simply click (or tap) on the area of the injury and watch a short video (60 sec to 2 min) on how to perform the block for the outlined area.