Wiederhold Benjamin D., Garmon Emily H., Peterson Elisha, Stevens Joshua B., O'Rourke Maria C.
St Joseph Medical Center
Baylor Scott & White Medical Center - Temple
The purpose of peripheral nerve blocks is to inhibit impulse transmission distally in a nerve terminal, thus terminating the pain signal perceived by the cortex. Nerve blocks can be used to treat acute pain (e.g., procedural anesthesia and perioperative analgesia), as well as for diagnosis and treatment of chronic pain. Impulse blockade can be brief (hours) or prolonged (months), depending on the medication used in the block and the technique (e.g., single-shot block versus catheter). Nerve blocks are also useful in the emergency department for the following indications: Acute pain management of the extremities. Anesthesia of the extremity for procedures. Alternative to procedural sedation. Alternative to opioids in certain patient populations (e.g., a head injury patient, patients with concomitant mental status change, patients on buprenorphine). Many nerves can be blocked depending on the injury. These include the following upper or lower extremities: Brachial plexus roots at the interscalene location block the shoulder, upper arm, elbow, and forearm. Brachial plexus trunks at the supraclavicular location block the upper arm, elbow, wrist, and hand. Brachial plexus cords at the infraclavicular location block the upper arm, elbow, wrist, and hand. Brachial plexus branches at the axillary location block the forearm, wrist, hand, and elbow, including the musculocutaneous nerve. . The median nerve at the elbow blocks the hand and forearm. The radial nerve at the elbow blocks the hand and forearm. The ulnar nerve at the elbow blocks the hand and forearm. The femoral nerve at the femoral crease blocks the anterior thigh, femur, knee, and skin anesthesia over the medial aspect of the leg below the knee. . The sciatic nerve at the subgluteal location or anterior approach below the femoral crease blocks the posterior aspect of the thigh and the anterior, lateral, and posterior lower leg, ankle, and foot. The sciatic nerve at the popliteal location blocks the anterior, lateral, and posterior lower leg, ankle, and foot. Ankle block of five separate nerves to the ankle and foot (saphenous nerve, deep peroneal nerve, superficial peroneal nerve, posterior tibial nerve, and sural nerve) blocks the entire foot.
外周神经阻滞的目的是抑制神经末梢远端的冲动传导，从而终止皮质所感知的疼痛信号。神经阻滞可用于治疗急性疼痛（如手术麻醉和围手术期镇痛），也可用于慢性疼痛的诊断和治疗。根据阻滞所用药物和技术（如单次阻滞与置管）的不同，冲动阻断可短暂（数小时）或延长（数月）。神经阻滞在急诊科也适用于以下情况：四肢急性疼痛管理；肢体手术麻醉；替代程序性镇静；在某些患者群体中替代阿片类药物（如头部受伤患者、伴有精神状态改变的患者、使用丁丙诺啡的患者）。根据损伤情况，许多神经都可被阻滞。这些神经包括以下上肢或下肢神经：在斜角肌间隙部位的臂丛神经根阻滞肩部、上臂、肘部和前臂；在锁骨上部位的臂丛神经干阻滞上臂、肘部、腕部和手部；在锁骨下部位的臂丛神经束阻滞上臂、肘部、腕部和手部；在腋窝部位的臂丛神经分支阻滞前臂、腕部、手部和肘部，包括肌皮神经。肘部的正中神经阻滞手部和前臂；肘部的桡神经阻滞手部和前臂；肘部的尺神经阻滞手部和前臂；腹股沟韧带中点处的股神经阻滞大腿前部、股骨、膝关节以及膝关节以下小腿内侧的皮肤麻醉。臀下部位或腹股沟韧带中点以下前入路的坐骨神经阻滞大腿后部以及小腿前侧、外侧和后侧、踝关节和足部；腘窝部位的坐骨神经阻滞小腿前侧、外侧和后侧、踝关节和足部。对踝部和足部五条独立神经（隐神经、腓深神经、腓浅神经、胫后神经和腓肠神经）进行踝部阻滞可阻滞整个足部。
