Peripheral Nerve Blocks: Clinical Protocol and Best Practices

Pre-Procedure Assessment

Patient Evaluation

• Review medical history and contraindications
• Assess coagulation status
• Document pre-existing neurological deficits
• Verify informed consent

Equipment Preparation

• Ultrasound machine with appropriate probe
• Sterile drapes and equipment
• Local anesthetic solutions
• Emergency medications

Procedure Protocol

1. Safety Measures

• Time-out verification
• Site marking
• Sterile technique implementation
• Patient monitoring setup

2. Technical Implementation

Ultrasound-Guided Technique

1. Position patient appropriately
2. Perform preliminary scan
3. Mark injection site
4. Prepare sterile field
5. Maintain visualization during advancement

Medication Administration

• Calculate maximum safe dose
• Perform aspiration test
• Inject incrementally
• Monitor spread pattern

Post-Procedure Care

Monitoring Requirements

• Vital signs q15 minutes x 4
• Sensory and motor function assessment
• Document block effectiveness

Discharge Criteria

• Stable vital signs
• Adequate pain control
• Written instructions provided
• Follow-up plan established

Complications Management

Early Recognition

• Local anesthetic systemic toxicity (LAST)
• Vascular injury
• Pneumothorax (location-specific)

Emergency Response

• LAST kit accessibility
• Emergency algorithms
• Documentation requirements

Documentation Requirements

Essential Elements

1. Informed consent
2. Procedure notes
3. Medications used
4. Post-procedure assessment
5. Follow-up plan