I. Ulnar Nerve

Diagnostic, therapeutic and operative interventions in the area of

innervation, completion of incomplete brachial plexus block.

Special Contraindications:

none

Landmarks:

Medial epicondyle of humerus1, olecranon2

Puncture site:

1-2 cm proximal from the palpated ulnar nerve in the ulnar groove3

Insertion of needle:

Introduce the needle in direction to the longitudinal axis of humerus

1-2 cm deep

Dosage:

2-5 ml 1% prilocaine or 0,5% bupivacaine

Indications:
Diagnostic, therapeutic and operative interventions in the area of
innervation, completion of incomplete brachial plexus block

Special Contraindications:
none

Landmarks:
Medial epicondyle of humerus, brachioradialis m., biceps tendon

Puncture site2:
In the cleft1 between the brachioradialis m. and the biceps tendon at
the level of elbow joint

Insertion of needle:
Push the needle in a proximal and lateral direction to the lateral
margin of lateral epicondyle of humerus. When bone contacted,
infiltrate 2-4 ml local anaesthetic: then advance in a cranial
direction about 1-3 cm in the longitudinal axis of the humerus,
contact the bone again and retract the needle 2-5 mm.

Dosage:
1 0 - 1 5 ml 1% lignocaine or prilocaine or 0,5% bupivacaine

Indications:
In combination with median nerve block and radial nerve block, all
operations on the hand

Special Contraindications:
none

Landmarks:
Flexor carpi ulnaris tendon2.Palmaris longus tendon3

Puncture site4:
Directly lateral to the flexor carpi ulnaris tendon

Insertion of needle:
Introduce the cannula vertical to the skin 0.5-1 cm deep (if there is a
strong resistance to injection, retract 2 mm)

Dosage:
2 ml 1 % lignocaine or prilocaine or 0,5% bupivacaine

Indications:
In combination with ulnar
nerve block and radial nerve
block, all operations on the
Hand

Special Contraindications:
none

Landmarks:
Palmaris longus tendon1

Puncture site3:
Directly lateral to the palmaris longus tendon

Insertion of needle:
Introduce the cannula vertical to the skin 0,5-1 cm deep (if there is a
strong resistance to injection, retract 2 mm)

Dosage:
2 ml 1 % lignocaine or prilocaine or 0,5% bupivacaine

Indications:
In combination with ulnar nerve block and median nerve block, all
operations on the hand Special Contraindications: none
Landmarks:
Pulsation of the radial a.1
Puncture site2:
About 1 cm lateral to the pulsation of the radial a.
Insertion of needle:
Parallel to the wrist subcutaneously
Dosage:
5 ml 1% lignocaine or prilocaine or 0,25% bupivacaine

I. Posterior Sciatic Nerve Block



Indications:
In combination with the 3 in 1-block, all operations on the lower limb
Special Contraindications: none
Landmarks::
Posterior superior iliac spine1, greater trochanter2
Puncture site:
3 cm below middle of line joining 1 & 2
Insertion of needle:
Introduce the needle vertical to the skin 6-8 cm deep
Dosage:
20-30 ml 1 % lignocaine or prilocaine or 0,5% bupivacaine


II. Anterior Sciatic Nerve Block

Landmarks:
Inguinal ligament1, greater trochanter2
Puncture site:
At the point of intersection of a line from the junction of the middle
third and the medial third of the inguinal ligament with a line parallel to
the inguinal ligament at the greater trochanter level
Insertion of Needle:
Slight lateral direction to contact the femur, retract the needle to the
subcutaneous area and correct the direction until the needle slides
off the femur, then push forward approx. 5 mm
Dosage:
10-20 ml 1% lignocaine or prilocaine or 0,5% bupivacaine


3 in 1-block

The lumbar plexus is "sandwiched" (Winnie) between the psoas major m. and the quadratus
lumborum m. and enveloped by their sheaths
Local anaesthetic runs up from the injection site and blocks the femoral n., the lat. cut. n. of
thigh and the obturator n.
Indications:
In combination with sciatic nerve block, all operations on the lower
limb
Special Contraindications:
none
Landmarks:
Inguinal ligament2, femoral a.1
Puncture site:
Below the inguinal ligament, 1-1,5 cm lateral from the femoral a.
Insertion of Needle:
In slightly cranial direction
Dosage:
25—30 ml 1 % lignocaine or prilocaine or 0,5% bupivacaine

Indications:
Completion of incomplete peridural anaesthesia or sciatic nerve
block, diagnostic, therapeutic and operative interventions in the
area of innervation, especially fractures of the lateral part of the
ankle and ruptures of the lateral ligament.
Special Contraindications:
none
Landmarks:
Head of fibula1, biceps femoris tendon2
Puncture site3:
Immediately posterior to fibula, 2 cm below head
Insertion of needle:
Introduce the needle vertical to the skin approx. 1 cm deep
Dosage:
5 ml 1 % lignocaine or prilocaine or 0,5% bupivacaine

Indications:
Completion of incomplete peridural anaesthesia or sciatic nerve
block; in combination with common peroneal and saphenous
nerve block: operations in the area of lower leg and foot
Special Contraindications:
none
Landmarks:
Internal and external epicondyles of femur, medial and lateral gastrocnemius
m.
Puncture site:
In the middle of the line connecting the lateral and medial epicondyles
of femur.
Insertion of needle:
Introduce the needle vertical to the skin 1,5-3 cm deep
Dosage:
5-10 ml 1% prilocaine or 0,5% bupivacaine

Indications:
Completion of incomplete femoral nerve block, in combination with
tibial and fibular nerve block: operations of lower leg and foot
Special Contraindications:
none
Landmarks:
Medial condyle of tibia, pes anserinus, tibial tuberosity 1, gastrocnemius
m.
Puncture site:
At the medial part of the tibial tuberosity
Insertion of needle:
S.c. infiltration from the medial part of the tibial tuberosity to the gastrocnemius
m.
Dosage:
5-10 ml 1% lignocaine or prilocaine or 0,5% bupivacaine

Indications:
All operations of foot and toes

Special Contraindications:
none

Landmarks:
Medial malleolus1, tibial a.2
Puncture sites:
On both sides of the tibial a.
Insertion of needle:
Introduce the needle vertical to the skin 0,5-2 cm deep
Dosage:
2-3 ml of 1% prilocaine or 0,5% bupivacaine

Landmarks:
Dorsalis pedis a.2
Puncture sites:
On both sides of dorsalis pedis a.
Insertion of needle:
Introduce the needle vertical to the skin directly beside the artery, up to
slightly below it. Repeat on other side of a.
Dosage:
2-3 ml 1 % lignocaine or prilocaine or 0,5% bupivacaine for each
injection

Landmarks:
Lateral malleolus1, tibial edge, achilles tendon
Insertion of needle:
S. c. infiltration from the tibial edge to the achilles tendon about one
hand's breadth above the lateral malleolus ^
S.c. infiltration from the tibial edge to the achilles tendon about one
hand's breadth above the medial malleolus
Dosage:
10-20 ml of 1% prilocaine or 0,25%-0,5% bupivacaine