Block Tray Set-Up

A thorough and ergonomically prepared regional block tray is a prerequisite for successful and time-efficient administration of regional blocks. Unless the operator has all equipment prepared and ready to use, the performance of regional blocks will be quite laborious. Regional anesthesia trays can obviously be set-up in many different ways, to accommodate local practice settings and commonly used techniques. However, here we just suggest a basic setup which is quick to prepare and works very well in our practice.

We routinely use a small instrument tray (1). First, we open a pack of sterile surgical towels (2) and drape the tray. Then, we simply add and arrange the following equipment on the tray:
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  1. Sterile gloves
  2. Sterile 4 x 4 gauze
  3. Three 20 ml syringes for local anesthetic
  4. A skin marker with a ruler
  5. Electrode for nerve stimulator
  6. Insulated nerve stimulator needle of desired length
  7. A 25G 1½ inch needle for skin infiltration
  8. Optional injection pressure monitor

While this is a common setup for a nerve-stimulator assisted nerve block, other equipment that is used with various blocks may be simply added. These may include stopcocks, various block needles, control syringes, extension tubing etc. The setup is not complete without nerve stimulator, syringes for premeditation and solution for skin preparation, which we keep off the tray.

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Needle sizes for peripheral nerve blocks

Choose the needle of appropriate size for each and every block technique!

A needle that is too short will obviously not reach its targeted depth, whereas a needle of excessive length is much more difficult to control during advancement. In addition, excessive-ly long needles tend to be inserted too far and, possibly resulting in serious complications. The recommendations in the table bellow are general recommendations only and they apply to nerve block techniques practiced at our institution and featured on NYSORA.

BLOCK TECHNIQUE RECOMMENDED NEEDLE LENGTH
Cervical plexus block 50 mm (2 in)
Interscalene brachial plexus block 25 mm (1 in) to 50 mm (2 in)
Infraclavicular brachial plexus block 100 mm (4 in)
Axillary brachial plexus block 25 (1 in) to 50 mm (2 in)
Thoracic paraverterbral block 90 mm (3.5 in - 4 in)
Lumbar paravertebral 100 mm (4 in)
Lumbar plexus block 100 mm (4 in)
Sciatic block posterior approach 100 mm (4 in)
Sciatic block anterior approach 150 mm (6 in)
Femoral block 50 mm (2 in)
Popliteal block posterior approach 50 mm (2 in)
Popliteal block lateral approach 100 mm (4 in)

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DISCLAIMER: The material presented on this Web page has not been peer-reviewed. The indications, techniques and dosages on this Web page have been recommended in the medical literature and/or conform to OUR clinical practice. The medications and equipment have not necessarily been approved by the Food and Drug Administration (FDA) for use in the techniques and dosages for which they are recommended. The package insert for each drug and/or equipment should be consulted for use and dosage as recommended by the FDA. Because standards, practices and recommendations change, it is advisable to keep abreast of revised recommendations, particularly those concerning new drugs and techniques. While the techniques and dosages described are successfully used in our practice, they should be followed with a discretion since their complications may be dependent on the operator, patient and/or other accompanying clinical circumstances. The development and maintenance of this web page has not been supported by any pharmaceutical or medical manufacturing industry. The medications and/or equipment discussed in the web page is shown solely for teaching purposes. Similar equipment or medications from other manufacturers may produce similar clinical results to ours.