Peripheral Nerve and Joint Blocks
Core concepts
Understand ultrasound-guided peripheral nerve blocks (brachial plexus, femoral, sciatic, intercostal, genicular, ilioinguinal), joint injections (shoulder, hip, knee), and trigger point and bursa injections. Know relevant anatomy, target planes, and structures to avoid (vessels, pleura, nerves you intend to spare).
Technique principles
Ultrasound improves accuracy and safety; hydrodissection and in-plane needle approaches reduce nerve injury. Know local anesthetic duration and toxicity thresholds, and when steroid adds value (inflammatory joint or bursitis) versus when it does not.
Traps
- Injecting into a tendon or nerve rather than the intended plane.
- Missing infection as a contraindication to joint injection.
- Overlooking pneumothorax risk with intercostal or supraclavicular approaches.
- Assuming a block's relief predicts long-term outcome without a repeatable pattern.
Worked rule of thumb
Before any peripheral block, identify the target, the danger structures, and the endpoint (spread pattern or paresthesia-free injection). If you cannot see the target and the danger structure simultaneously, adjust the approach.
Post-procedure
Counsel on duration of anesthesia, fall precautions with lower-extremity blocks, and expected steroid onset over days.