NOTA PROCEDURAL SKILLS MUHAMMAD DANIAL BIN AHMAD HELMI
Direct Observational Procedural Skills Notes
Blocks
Bila nak kasi LA ni, digalakkan untuk guna LA paling concentrated, contohnya Lidocaine 2%,
without adrenaline.
Dosage of Lidocaine
with epinephrine =7mg/kg
without epinephrine =3mg/kg
(Lidocaine 2% w/v solution for injection: Each 1 ml of solution for injection contains 20mg of
lidocaine hydrochloride.)
Local anaesthetic systemic toxicity
1. CNS Depression
2. Ventricular dysrhythmia
3. Hypotension
4. Seizures
5. Hypoxia
6. Lip numbness
Techniques
Ring blocks
a) Volar Approach
Favored approach. Use a direct approach at 90 degress slightly distal to the MCP joint.
1. Insert the needle through the skin leaving a small wheel of LA superficially
2. Aim the needle approx 45 degree laterally towards either web space
3. Direct the needle into the web space, aspirate, then inject 0.5 to 1mL of LA at different
regions throughout the webspace
4. Without leaving the skin at the point of the superficial wheel, redirect the needle to the
opposite web space, repeating the aspiration-injection technique.
5. For a normal size finger, 3cc mL is enough la
6. Adjust the amount if the finger is small, as the amount of fluid may cause compression of
vessels and nerves.
7. If anaesthesia tak cukup, repeat the block using dorsal approach and leave a complete ring
block.
8. NEVER use adrenaline in the finger or with a digital block. Gangrene nanti!
b) Dorsal approach
1. Essentially the same
2. Mesti berjaga2 takut terpenetrate the extensor tendon on the dorsum of the finger
3. Boleh dielakkan dengan dua cara
1. Pinch the skin slightly distal from the MCP joint using this area as your point of entry
for a 90 degree approach; mulakan dengan 45 degree approach
c) Web space approach
Direct Observational Procedural Skills Notes
Blocks
Bila nak kasi LA ni, digalakkan untuk guna LA paling concentrated, contohnya Lidocaine 2%,
without adrenaline.
Dosage of Lidocaine
with epinephrine =7mg/kg
without epinephrine =3mg/kg
(Lidocaine 2% w/v solution for injection: Each 1 ml of solution for injection contains 20mg of
lidocaine hydrochloride.)
Local anaesthetic systemic toxicity
1. CNS Depression
2. Ventricular dysrhythmia
3. Hypotension
4. Seizures
5. Hypoxia
6. Lip numbness
Techniques
Ring blocks
a) Volar Approach
Favored approach. Use a direct approach at 90 degress slightly distal to the MCP joint.
1. Insert the needle through the skin leaving a small wheel of LA superficially
2. Aim the needle approx 45 degree laterally towards either web space
3. Direct the needle into the web space, aspirate, then inject 0.5 to 1mL of LA at different
regions throughout the webspace
4. Without leaving the skin at the point of the superficial wheel, redirect the needle to the
opposite web space, repeating the aspiration-injection technique.
5. For a normal size finger, 3cc mL is enough la
6. Adjust the amount if the finger is small, as the amount of fluid may cause compression of
vessels and nerves.
7. If anaesthesia tak cukup, repeat the block using dorsal approach and leave a complete ring
block.
8. NEVER use adrenaline in the finger or with a digital block. Gangrene nanti!
b) Dorsal approach
1. Essentially the same
2. Mesti berjaga2 takut terpenetrate the extensor tendon on the dorsum of the finger
3. Boleh dielakkan dengan dua cara
1. Pinch the skin slightly distal from the MCP joint using this area as your point of entry
for a 90 degree approach; mulakan dengan 45 degree approach
c) Web space approach
