Procaine blocks

Circular (compartment) limb blocks

The technique is based on injecting an anesthetic (usually a 0.25% solution) directly into the fascial compartments of muscles. The solution spreads within these enclosed spaces, providing anesthesia to the distal parts of the limb.

• Arm block. The puncture is made on the anterior surface of the middle third of the arm. Using a long needle, the skin and fascia are pierced, advancing the needle until it hits the humerus, after which it is slightly withdrawn. 50–60 ml of the solution is injected into the fascial compartments of the biceps and triceps muscles.
• Forearm block. Performed at the level of the middle third. The drug is injected into the flexor and extensor fascial compartments, 60–80 ml into each.
• Thigh block. The needle is inserted in the middle third of the thigh on the anterior surface, advancing until it contacts the bone. A volume of 150–180 ml of the solution is injected in a single dose.
• Leg block. Performed in the middle third of the leg. Landmarks are the puncture sites on the lateral and medial sides of the tibia. 80–100 ml is injected into the flexor and extensor compartments.

Cervical vagosympathetic block

This procedure is indicated for the prevention and treatment of pleuropulmonary shock in chest trauma.

Patient position: supine, with a bolster under the neck and the head turned to the side opposite to the procedure. The arm on the side of the block is pulled down firmly.

Execution Technique:

1. The puncture point is located at the posterior edge of the sternocleidomastoid muscle (m. sternocleidomastoideus), using its intersection with the external jugular vein as a landmark.
2. Skin anesthesia is performed with a 0.25% solution (creating a "lemon skin" wheal).
3. The physician presses on the wheal with the index finger of the left hand, displacing the muscle and vessels anteriorly and medially.
4. The long needle is advanced upward and medially toward the anterior surface of the spine, constantly performing an aspiration test.
5. 40–50 ml of a 0.25% solution is injected (on each side in bilateral blocks).

The clinical sign of a successful block is the appearance within a few minutes of Horner's sign (pupil dilation is noted in the described technique) on the side of injection.

Lumbar (perirenal) block

Used in transfusion shock, intestinal paresis, and as a basis for local anesthesia during retroperitoneal surgeries.

Position: the patient lies on the healthy side, with a bolster placed under the lumbar region. The upper leg is straightened, and the lower leg is flexed at the knee.

Execution Technique:

• The puncture site is found along the bisector of the angle formed by the 12th rib and the erector spinae muscle, stepping back 1–1.5 cm from the apex.
• The long needle is inserted perpendicularly to the body surface.
• Passing through the lumbar fascia is felt as overcoming resistance, after which the needle enters the perirenal adipose tissue.
• After an aspiration test, 60–80 ml of anesthetic is injected on each side.

The injected solution spreads through the retroperitoneal tissue, bathing the renal, adrenal, solar plexuses, and splanchnic nerves. A sure sign of correct needle placement: when the syringe is disconnected, the liquid does not leak outward.

Intra-abdominal and retromammary blocks

Braun's intra-abdominal celiac plexus block Performed after laparotomy during gastric resection. The liver is retracted to the right and upward, and the stomach to the left and downward. The aorta is palpated in the lesser omentum area. The index finger is fixed to the right of the aorta, resting against the spine. The needle is guided along the finger until it hits the body of the 12th thoracic vertebra (Th XII). 50–70 ml of a 0.5% solution is injected. The effect develops in 5–10 minutes and lasts up to 1.5–2 hours. The drug spreads in the retroperitoneal space, bathing the solar plexus.

Retromammary block Indicated for early forms of mastitis and breast surgery.

• A 0.5% solution is injected intracutaneously at the base of the gland (at 3–4 points).
• Using a long needle through these points, the retromammary space is entered, injecting a 0.25% solution (50 ml at each puncture site).
• The solution should flow without resistance. Visual sign of correct injection: the mammary gland is elevated and rests "as if on a pillow".

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Anatomy of the fascial compartments of the upper and lower extremities
• Topography of the fascial spaces of the neck and retroperitoneal space
• Differential diagnosis of types of traumatic shock
• Pharmacodynamics of procaine and lidocaine in soft tissues

Other topics in the section "CHAPTER 3. ANESTHESIA"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.