Nerve Blocks for the Masses: Loss of Resistance Blocks

Vol 3 | Issue 2 | May-Aug 2017 | page: 43-57 | Shiv Kumar Singh

Authors: Shiv Kumar Singh [1]

[1] Department of Anesthesiology, Royal Liverpool University Hospitals, Prescot Street, Liverpool.

Address of Correspondence
Shiv Kumar Singh
Royal Liverpool University Hospitals, Prescot Street, Liverpool L7 8XP.

The Anaesthetist Society

Buddha said, “There is no wealth like knowledge and no poverty like ignorance.”

Facebook group “The Anaesthetist” was born on 21st February 2012 by the initiative of Dr. Vivek Gupta and moderated by Dr. Shiv Kumar Singh. Over the months the group grew steadily in numbers, and people were joining from all over the world, but most were from the Indian Subcontinent and the Middle East. The members from the West were again mostly of eastern origin. There were some members from the European and South American countries as well, who do regularly participate in the activities. In less than a year we were more than 1000 members strong, and in the past 3 years, our strength has grown to more than 5000 dedicated members.
On 25th October 2013, we launched the logo competition. Aashish Jain was the 1st person to submit his entry, and this initiated many more to participate with great enthusiasm. The creativity exhibited by the members who took part really surprised me. The competition was won by Sunny Bhasin. The logo of the society signifies the activities of an anaesthetist.
In November 2013, Hetal Vadera organized a Regional Anaesthesia workshop at Rajkot; this was the first time that many of the members from the group met face to face. The workshop was a great success and was the catalyst that started the reaction of stronger friendship and camaraderie among the members.
The workshop created enthusiasm among members to use RA as part of multimodal analgesia and improve the quality of care for their patients.
On 5th November 2013, the idea of TACON (The Anaesthetist Conference) was floated and by 5th December, within a month, the Venue (India International Centre [IIC]) was booked for the conference by Anil Sharma who took up the challenge.
On 24th March 2014, the group got registered as a society, The Anaesthetist Society or TAS as most members call it. The TACON 2014 was held at the prestigious IIC on the 14th and 15th November. It was a grand success with members from all over the world interacting academically and socially, the bond was further strengthened.
Since the next TACON would be in 2016, it was decided that we would hold few workshops in 2015 and “Nerve Blocks for The Masses” Rajkot 2015 is 1st of these workshops where we will discuss and demonstrate loss of resistance (LOR) and peripheral nerve stimulator guided blocks. This workshop will remind the members the first unofficial meeting of the TASians.
This booklet has been specifically produced for the members to practice blocks that can be done by anyone anywhere even in the remotest of the places.

Good Luck

Introduction to Loss of Resistance Technique
The LOR techniques rely on using blunt or short-beveled needles, which provide a good feedback (pops or clicks) when they pass through the various fascia. There are some simple blocks that can be performed with just a needle and some local anaesthetics (LA). These blocks, if done properly, provide good analgesia for most common procedures on the abdomen and for fracture neck of femurs. These blocks include; rectus sheath block (RSB), transversus abdominis plane (TAP), ilioinguinal (IIN), and fascia iliaca compartment block (FICB).
The success of these blocks depends on two main things, one understanding the surgical anatomy and second on understanding the “cushion effect” that occurs at the skin level while using LOR needles.
It also important to understand that these blocks provide relief only from somatic pain and multimodal analgesia must be provided to all patients. These are “volume blocks” and one should always use LA within its safe limits. Volume can be in reased using lower concentrations.
In this booklet, we describe the common blocks and techniques that can used to provide analgesia in some of the commonly performed surgical procedures such as lower segment Cesarean section, appendectomy, inguinal hernia, bladder surgeries, open prostatectomy, and even for laparotomies. FICB can be used for hip fractures, total hip replacements, fracture patella, total knee replacement, and skin grafts.

  • Loss of resistance Needles
  • LOR Blocks: Transversus Abdominis Block
  • LOR Blocks: Rectus Sheath Block
  • LOR Blocks: IIN Block
  • LOR Blocks: Fascia lliaca Compartment Block
  • LOR Blocks: Paravertebral Block
  • LOR Blocks for Surgeries

Please refer to PDF for more details
Download Pdf: Click here


How to Cite this Article: Singh S. Nerve Blocks for the Masses: Loss of Resistance Blocks.    Journal of Anaesthesia and Critical Care Case Reports     May-Aug 2017; 3(2): 43-57.


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