Injury/surgery | Anesthesia technique | Analgesic technique |
Clavicle fracture | ||
Proximal | General | |
Mid | General | Interscalene block or clavipectoral block ± superficial cervical plexus block |
Distal | General or interscalene ± superficial cervical plexus block* | Interscalene block or clavipectoral block ± superficial cervical plexus block¶ |
Shoulder dislocation | Sedation, interscalene block, or general | Systemic |
Humerus fracture | ||
Proximal | General or interscalene block* | Interscalene block or supraclavicular block |
Distal | General or supraclavicular or infraclavicular block + intercostobrachial nerve block | Supraclavicular block or infraclavicular block |
Forearm fracture or hand fracture | General or supraclavicular block, infraclavicular block, or axillary block | Supraclavicular block, infraclavicular block, or axillary block |
Pelvic fracture | General | Lumbar epidural (caution spine injury) |
Femur fracture | ||
Hip or proximal femur | General or neuraxial | Femoral nerve block, fascia iliaca block, lumbar plexus block, PENG block, or epidural analgesia |
Midfemoral or distal | General, neuraxial, or combined femoral, sciatic, lateral femoral cutaneous, and obturator nerve blocks | Femoral nerve block ± sciatic nerve block or epidural analgesia |
Patella fracture | General, neuraxial, or femoral nerve block | Femoral nerve block or adductor canal block |
Tibial plateau fracture | General or neuraxial | Femoral and sciatic nerve blocks (if catheter, avoid boluses of local anesthetic that would hinder monitoring for compartment syndrome) |
Tibial shaft fracture | General, neuraxial, or sciatic + saphenous (femoral or adductor canal) nerve blocks | Sciatic nerve block (popliteal or subgluteal) + saphenous nerve block (adductor canal or femoral) |
Ankle fracture | General, neuraxial, or sciatic + saphenous (femoral or adductor canal) nerve blocks | Sciatic nerve block (popliteal or subgluteal) + saphenous nerve block (adductor canal or femoral) |
PENG: pericapsular nerve group.
* General anesthesia may be preferred because the surgical field is very close to the face and airway.
¶ The superficial cervical plexus may be missed with the clavipectoral block, or if low volume local anesthetic is used for interscalene block to avoid phrenic nerve block.Do you want to add Medilib to your home screen?