How it works: pick a region on the body or search the site you want to numb, open a block, then follow its three steps: overview, 3D anatomy, scan and needle. Found a problem? Report it with the 🐞 button at the top.
Pick a region
Tap a region · drag to turn
Loading 3D
Opening the block…
Indications
Avoid or take care
What gets blocked by nerve
| Nerve | Supplies | Effect |
|---|
Where it goes numb skin, approximate
Loading 3D
Motor effect
How it is done
Dose check
75mg planned200mg ceiling38% of ceiling
Ceilings are commonly quoted plain-solution maxima (ropivacaine 3 mg/kg to 200 mg, bupivacaine and levobupivacaine 2 mg/kg to 150 mg, lidocaine 4.5 mg/kg to 300 mg or 7 mg/kg to 500 mg with adrenaline). References and formularies differ: use your institution's limits, and go lower in the elderly and in hepatic, cardiac or renal disease. A ceiling is not a target.
LAST: act fast
- Stop injecting, call for help, 100% oxygen, secure the airway
- Seizures: benzodiazepine first
- 20% lipid emulsion. Over 70 kg: 100 mL over 2–3 min, then 200–250 mL over 15–20 min. 70 kg or less: 1.5 mL/kg over 2–3 min, then 0.25 mL/kg/min
- If still unstable: repeat the bolus once or twice and double the infusion; stay under about 12 mL/kg in total
- Arrest: CPR, adrenaline in small doses (≤1 µg/kg); avoid vasopressin, calcium-channel and β-blockers, and more local anaesthetic; think early about ECMO
From the ASRA local anaesthetic systemic toxicity checklist, 2020 version.
Sources
Loading anatomy
TargetOther nervesArteriesVeinsLandmarksTap a structure to name it
Loading
Scan planeNeedle
Positions
Slide
Rotate
Tilt
Rock
Pressurenone
Probe
Drag the probe in the 3D view. Keys in the 3D view: arrows slide, Q/E rotate, W/S tilt, A/D rock, +/− pressure; hold Shift for bigger steps.
L 12 MHz · linearDepth 3.4 cmGain 54%
Anatomy in the scan plane · 3D model
Finding the view
Numbered patches on the skin match the steps; the blue line is the path.
The procedure
Tap a step to play it. The camera follows the needle until you turn the model.