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.