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Orthopedic injury/surgery and anesthetic and analgesic choices

Orthopedic injury/surgery and anesthetic and analgesic choices
Injury/surgery Anesthesia technique Analgesic technique
Clavicle fracture
Proximal General  
Mid General Interscalene block or clavipectoral block ± superficial cervical plexus block
Distal General or interscalene ± superficial cervical plexus block* Interscalene block or clavipectoral block ± superficial cervical plexus block
Shoulder dislocation Sedation, interscalene block, or general Systemic
Humerus fracture
Proximal General or interscalene block* Interscalene block or supraclavicular block
Distal General or supraclavicular or infraclavicular block + intercostobrachial nerve block Supraclavicular block or infraclavicular block
Forearm fracture or hand fracture General or supraclavicular block, infraclavicular block, or axillary block Supraclavicular block, infraclavicular block, or axillary block
Pelvic fracture General Lumbar epidural (caution spine injury)
Femur fracture
Hip or proximal femur General or neuraxial Femoral nerve block, fascia iliaca block, lumbar plexus block, PENG block, or epidural analgesia
Midfemoral or distal General, neuraxial, or combined femoral, sciatic, lateral femoral cutaneous, and obturator nerve blocks Femoral nerve block ± sciatic nerve block or epidural analgesia
Patella fracture General, neuraxial, or femoral nerve block Femoral nerve block or adductor canal block
Tibial plateau fracture General or neuraxial Femoral and sciatic nerve blocks (if catheter, avoid boluses of local anesthetic that would hinder monitoring for compartment syndrome)
Tibial shaft fracture General, neuraxial, or sciatic + saphenous (femoral or adductor canal) nerve blocks Sciatic nerve block (popliteal or subgluteal) + saphenous nerve block (adductor canal or femoral)
Ankle fracture General, neuraxial, or sciatic + saphenous (femoral or adductor canal) nerve blocks Sciatic nerve block (popliteal or subgluteal) + saphenous nerve block (adductor canal or femoral)

PENG: pericapsular nerve group.

* General anesthesia may be preferred because the surgical field is very close to the face and airway.

¶ The superficial cervical plexus may be missed with the clavipectoral block, or if low volume local anesthetic is used for interscalene block to avoid phrenic nerve block.
Graphic 108491 Version 4.0