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.