Field Block Anesthesia

00:04 In this video I'd like to show you is called a field block.

00:07 Field blocks are a very useful tool to help with pain in such a way that you don't have to actually get into the incision and provide anesthesia directly in the area you're working.

00:17 In fact, you instead will go proximal to the area working if you're on an extremity.

00:21 The way this works is you have one side of the wound is distal. One side is proximal.

00:26 The sensation of pain is going to go from distal to proximal up to the brain.

00:30 And your role in this is to think about this in response to where the patient's pain is going to travel.

00:35 On the extremities is pretty typical to have it go up the extremity towards the core.

00:39 That said, when you're on the core of the body, on the torso, or abdomen, or wherever you're working, realize that you may have two different nerve branches that are going to this area and providing you with a pain response.

00:50 So you have to think about this in a different way.

00:52 You can't just provide proximal control for the anaesthetic.

00:55 You have to work entirely around it in a four quadrant box so to speak.

01:01 So let's do a field block, you will think about this if you're on a extremity and it proximal manner.

01:06 Typically, all you have to do, if this is the incision I intend to make or this is the incision that came in as a laceration that you're going to be working on.

01:13 If you go to the proximal end, and go back about a centimeter or so, and you make a little skin bleb.

01:20 Okay, and once you've made your bleb onto the tissue, you can then - I'll show above the tissue, what's happening beneath the tissue.

01:26 Poke in, and then you'll drive your needle in a bleb in that linear fascia like I just showed you.

01:33 And then, once you've done that, you can come back, turn around to that same hole, and then you're going to angle down the opposite direction.

01:40 So and you're all done, you've created a V of anaesthesia on both sides.

01:46 So that everything pain wise is coming through here and hits this wall and nothing makes it up to the brain.

01:51 This is called a field block.

01:52 Now, what happens if you have something on the torso and you're going to work on this lesion? Well, this lesion potentially could send pain both directions.

02:00 So we're going to do a block on both sides.

02:02 And by doing this, we've created effectively a stadium around the game.

02:06 And the way I like to think about this is if you have four walls of a stadium around the baseball game, you can't watch from the outside unless you have that chain link fence that you can see through.

02:16 The pain can get right through that chain link fence.

02:19 Our goal is to make sure that we put a larger barrier around this.

02:23 And then, we've poked in over on this side too, and then made our angle up, and then our angle down.

02:28 We would account for four quadrants of a field block and no pain should be able to get through that.

02:33 That is called a field block.

02:35 Good and practice that now.