Peripheral nerve blocks are advantageous in the ED environment, particularly for procedures on the digits or penis. They require less total LA medication, and the site of drug delivery is often less painful than for local infiltration. It is important to document neurovascular status prior to application of the block, to prevent masking a primary traumatic neurovascular injury. The onset of anesthesia is more delayed than by direct infiltration and may be up to 15 min. The duration depends on the agent used and the amount of drug injected. Complications of nerve blocks include nerve injury. During a block, severe pain suggests that contact has been made with the nerve. In this circumstance, the needle must be withdrawn and repositioned before anesthetic is injected. Intravascular injection can result in limb and systemic toxicity. LA dose exceeding the maximum may result in systemic toxicity (primarily cardiac and CNS), as discussed above. In order to minimize the likelihood of intravascular injection, the plunger on the needle syringe apparatus should be drawn back in all nerve block procedures prior to infiltration. If blood is withdrawn, the procedure is halted. The suggested dosages for regional blocks are shown in I§blei3i2:11.
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