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 |