EM · Procedural & diagnostic ED skills

Regional nerve blocks in the emergency department

Also known as Regional nerve block · Fascia iliaca block · Femoral nerve block · Wrist block · Digital ring block · Facial nerve block · Field block · LAST (local anaesthetic systemic toxicity)

Regional nerve blocks in the ED — the fascia iliaca and femoral blocks for hip and femoral-shaft fracture analgesia (landmark and ultrasound-guided), the wrist block (median, ulnar, radial at the wrist) and the digital ring block for hand and finger procedures, and the facial blocks (supraorbital/supratrochlear, infraorbital, mental) for facial lacerations. The local anaesthetic agents (lidocaine 1 to 2 per cent, bupivacaine 0.25 per cent, ropivacaine 0.5 per cent) with the maximum safe doses (lidocaine 3 mg/kg plain, 7 mg/kg with adrenaline; bupivacaine 2 mg/kg; ropivacaine 3 mg/kg), ultrasound guidance where available, the recognition and lipid-rescue of local anaesthetic systemic toxicity, and the pitfalls (intravascular injection, nerve injury, compartment syndrome in the anticoagulated, adrenaline in the digit). ACEM-primary, globally tagged.

Checked against its sources on 2 Sept 2026