Procedural Guidelines & Responsibilities

 Procedural Guidelines

A. Verify appropriateness of block with attending surgeon, anesthesiologist, and Regional/CPS attending.

B. All patients will have a completed preop and consent in the chart prior to initiation of an regional technique.

C. Position patient appropriately.

D. Notify Regional/CPS attending.

E. Perform a time-out to confirm correct patient, site of surgery, consent, and verify surgical mark.

F. Use of nasal cannula oxygen @ 2L per minute prior to sedation.

G. Standard monitors include pulse oximetry, ECG, and blood pressure.

H. Prepare injectate (e.g. 0.5% Bupivacaine with 1:300,000 epinephrine).

I. Sedate patient with midazolam 1-5mg and fentanyl 25-100mcg when appropriate.

J. Identify and mark landmarks.

K. Sterile prep, using Chloraprep and sterile gloves.

L. All procedures are done using sterile technique.

M. Anesthetize skin and subcutaneous tissues with 1% lidocaine.

N. Identify anatomy and target nerves using ultrasound (optional).

O. With attending present, begin localization of desired nerve(s).

P. If using nerve stimulation, once desired twitches obtained, usually at <0.4 mA, begin slow    
    injection of local anesthetic solution over 2-3 minutes with frequent aspiration.

Q. Visualize spread of local anesthetic on ultrasound (optional).

R. When injection completed, withdraw needle, verify hemostasis.

S. Dispose of all sharps and waste in designated container.

T. Continue ASA monitors until patient goes to OR or for 30 minutes.

U. If possible, check block efficacy before operation begins.

V. Follow up on block efficacy, complications after the case. 

Responsibilites for CPS Service


Junior Resident

Senior Resident