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LEARNING PATHWAY · BEYOND PLAN A

Plan B, C and D blocks

The alternatives to each Plan A block: what to do when the Plan A block is not suitable, not enough, or you want to spare a nerve.

Each Plan A block has alternatives: blocks that spare the diaphragm or the quadriceps, cover a different area, or suit a patient on anticoagulants. They are grouped here under the Plan A block they back up. Learn the Plan A block first, then its alternatives.

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Pass the quiz at the end of each block page. When you have passed some or all of them, print a certificate for this pathway, with a reflection note for your appraisal.

Pathway certificate and reflection

Instead of interscalene (shoulder)

Diaphragm-sparing options and the supraclavicular approach.

  1. Superior trunk block
  2. Supraclavicular brachial plexus block
  3. Suprascapular nerve block: anterior and posterior approaches
  4. Axillary nerve block

Instead of axillary (arm, elbow, forearm and hand)

Other brachial plexus approaches and distal rescue blocks.

  1. Infraclavicular brachial plexus block
  2. Costoclavicular brachial plexus block
  3. Mid-humeral block
  4. Elbow block (median, radial and ulnar nerves)
  5. Forearm blocks (median, ulnar and superficial radial nerves)
  6. Wrist block
  7. Intercostobrachial nerve block
  8. Medial cutaneous nerve of the arm block

Instead of erector spinae (chest wall and back)

Paravertebral, chest wall plane blocks and the thoracic epidural.

  1. Thoracic paravertebral block (sagittal and transverse approaches)
  2. Serratus anterior plane block (superficial and deep)
  3. Interpectoral plane block (Pecs I)
  4. Pectoserratus plane block (Pecs II)
  5. Intertransverse process block (including the MTP block)
  6. Rhomboid intercostal and sub-serratus (RISS) block
  7. Superficial parasternal intercostal plane block (pecto-intercostal fascial block)
  8. Deep parasternal intercostal plane block (transversus thoracis plane block)
  9. External oblique intercostal (fascial plane) block
  10. Thoracic epidural

Instead of rectus sheath (abdominal wall)

Lateral and posterior abdominal wall blocks.

  1. Transversus abdominis plane (TAP) block: lateral and posterior approaches
  2. Subcostal (oblique subcostal) TAP block
  3. Quadratus lumborum blocks (lateral, posterior and anterior)
  4. TAPA and modified TAPA (M-TAPA) block
  5. Transversalis fascia plane block
  6. Ilioinguinal and iliohypogastric nerve block
  7. Deep rectus sheath (preperitoneal) block

Instead of femoral (hip and thigh)

Fascia iliaca, PENG and lumbar plexus blocks.

  1. Suprainguinal fascia iliaca block
  2. Infrainguinal fascia iliaca block
  3. PENG block (pericapsular nerve group)
  4. Lateral femoral cutaneous nerve block (lateral cutaneous nerve of the thigh)
  5. Lumbar plexus block (posterior approaches)

Instead of adductor canal (knee)

Other ways to cover the knee while sparing the quadriceps.

  1. Femoral triangle block
  2. IPACK block
  3. Genicular nerve block

Instead of popliteal sciatic (leg, ankle and foot)

Proximal sciatic approaches and the ankle block.

  1. Subgluteal sciatic nerve block
  2. Parasacral sciatic (sacral plexus) block
  3. Anterior sciatic nerve block
  4. Lateral sciatic nerve block
  5. CAPS block (crosswise approach to popliteal sciatic)
  6. Ankle block (all five nerves)

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