a) Inform the patient about the technique being used and obtain written consent before starting the procedure.
b) Closely inspect the proposed puncture site for infection and lesions before performing the puncture.
c) Position the patient appropriately, according to the block being done. Correctly disinfect the area and cover with a sterile drape before starting the procedure. Inject a skin wheal of local anaesthetic at the puncture site.
d) Inspect the puncture material closely, ensuring that it has been packaged correctly and the needle is sterile. If not in perfect condition or sterility has been compromised, discard immediately.
e) Connect the transparent cable to the Luer-Lock connection on the distal end of the needle's body, purge the system with 0.9% saline solution, or with the appropriate anaesthetic solution, until the liquid reaches the needle's tip.
f) If performing the technique with nerve stimulation, connect the metal connection of the electrical cable to one of the two orifices found on the body of the needle. This can be done either on the left or right-hand side depending on the patient's position and/or the anaesthesiologist's preference, and allowing connection of the nerve stimulator cable.
Connect the other end of the electrical cable to the nerve stimulator and then the nerve stimulator cable to the skin electrode and place it on the body in an area near to the nerve being blocked. Set the initial current at 0.5 to 2 mA with a pulse width of 0.1 to 0.3 ms.
Puncture the skin and slowly advance the needle towards the target nerve. If clear, muscular contractions are seen in the target nerve's area of distribution, reduce the electric current until the contractions disappear. If the level at which they disappear is between 0.3 and 0.5 mA the stimulation needle is situated at an appropriate distance from the nerve. If muscular contractions are produced with a current less than 0.2 retract the stimulation needle slightly as the tip is very close to, or within, the nerve fasciculate and this could cause lesions.
g) If the technique is being performed under ultrasound, the plexus needle features a system of specific grooves, in its last distal centimetre, allowing optimal, rapid visualisation of the needle tip. Likewise, the ergonomic grip℗ allows smooth, circumferential sliding movements making the ultrasonic tip flash more effective. This allows the technique to proceed safely and effectively as there is continual control of the tip position relative to the nerve.
Puncture the skin and advance the needle slowly, using the ultrasound equipment to localise the desired nerve or nerve trunk.
h) In both techniques, once correctly positioned and before administering the local anaesthetic, aspirate the syringe to ensure you are not close to a blood vessel. The plexus needle's body is transparent which aids very rapid detection of blood. If this occurs, withdraw the needle and reposition it.
i) Administer the desired anaesthetic, aspirating after every 5ml of anaesthetic solution.
j) If desired the two techniques of nerve localisation can be combined: ultrasound and stimulation.
k) The nerve block needle has length markings every 1cm. The ultrasound groove is only located in the distal centimetre.
l) Withdraw the needle, disinfect the skin and place a sterile dressing.
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