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Table 7 Regional blocks appropriate for wilderness are listed below, adapted from [180], LOE denotes level of evidence

From: Multiple trauma management in mountain environments - a scoping review

Regional block Indications LOE Remarks
Intra-articular injection Shoulder dislocation 2B Not superior to procedural sedation [189]
Intrascalene nerve block Shoulder/arm injuries 1C Phrenic nerve paralysis and respiratory compromise (not ideal for altitude) [190]
Supra- or infraclavicular block Pathology distal to shoulder 1B Small ultrasound probe; 20-25 mL local anaesthetic, pneumothorax
Axillary block Pathology distal to shoulder 1C Less anesthetic needed with ultrasound (~ 15 mL) [191]
Median/ulnar/radial block Distal forearm/hand/multiple 1C Nerves of mid-forearm readily seen with ultrasound; 3-5 mL [190]
Intercostal nerve block Isolated rib fracture(s) 1C Ideal if cardiorespiratory status with systemic analgesia worrisome [192]
Femoral nerve block Femur fracture/pathology 1C Not effective for posterior limb, or distal leg
3-in 1 block Femur/knee or distal extremity 1C For thigh and distal extremity/foot; lateral femoral cutaneous- femoral and obturator nerve [191, 193]
Fascia Iliaca block Femur fracture/pathology 1C 90% success rate prehospital, simple; less injury risk to nerves; ~ 30 mL [194]
Sciatic nerve block Posterior thigh/knee/distal lower extremity 1C With femoral and saphenous nerve block, good for knee and distal lesions [191]
Ankle nerve block Ankle/foot 2B Need to block 5 nerves; high failure rate, good for isolated foot lacerations