• Daniel PurcellEmail author
  • Eric M. Steinberg
  • Bryan A. Terry


Bony and soft tissue injuries that necessitate emergency department evaluation/intervention can be extremely painful and be associated with much patient apprehension. Various anesthetic procedures can be implemented to diminish patient discomfort, potentially leading to heightened overall outcomes. Performance requires a thorough understanding of the relevant procedural anatomy, pertinent technical skills, and the avoidance of possible barriers/pitfalls that can taper results. The following chapter will communicate a fundamental physiologic background of regional/local anesthesia, indications for utilization, a stepwise guide toward implementing a multitude of various anatomic anesthetic blocks, as well as key obstacles to elude during planning/execution. Advanced technique(s) regarding nociception for more significant injuries and/or desire for augmented pain relief are also categorically addressed.


Anesthesia Nociception Regional nerve block Local infiltration Digital nerve block: flexor tendon sheath Median nerve block: palmaris longus tendon Flexor carpi radialis tendon Radial nerve block: anatomic “snuffbox” Ulnar nerve block: palmar/dorsal sensory branch Anterior ankle block: tibialis anterior tendon Posterior tibial artery Posterior ankle block: sural nerve Achilles tendon 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Daniel Purcell
    • 1
    Email author
  • Eric M. Steinberg
    • 2
  • Bryan A. Terry
    • 3
  1. 1.Emergency DepartmentNew York University Langone Medical Center BrooklynNew YorkUSA
  2. 2.Department of Emergency MedicineMount Sinai Beth IsraelNew YorkUSA
  3. 3.The Brooklyn Hospital CenterBrooklynUSA

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