Combination blocks
Nov 06, 2025
When 2 become 1: combination regional blocks 🌿
Sometimes, one block just isn’t enough! Combination blocks pair two or more specific blocks (single shot or continuous catheter – or both!) to help extend surgical anaesthesia and/or provide a denser, site-specific analgesia. They are commonly used when one block just won’t cut it – here are some examples:
🔹 Femoral or fascia-iliaca block combined with a sciatic block for knee, tibial or ankle surgery
🔹 Interscalene or suprascapular block paired with a brachial plexus block for complex shoulder surgeries
🔹 Paravertebral or erector spinae block combined with intercostal or serratus blocks for thoracic surgeries or fractured ribs
The clinical advantages of this are superior analgesia in the peri and early postoperative phase, and helping to reduce opioid consumption. Effective regional blocks have been shown to facilitate early mobilisation and physiotherapy, and reduce length of stay for patients 🏥.
Of course, combination blocks create more complexity of care and increase the potential for risks and errors to occur. A formal block “time out” should be conducted before each block to ensure the correct site/side and informed consent for the procedures 📑.
Individual, clear documentation of the blocks is imperative to highlight that multiple regional blocks have been performed, in order to guide appropriate ongoing monitoring and care. If the blocks are continuous infusions, then clear, distinct labelling and documentation must be maintained for both infusions in order to avoid confusion. Vigilant monitoring for LAST must be maintained, as combination blocks can result in greater volumes of local anaesthetic being used, increasing the risk of adverse events ⚠️.
Combination blocks provide clinical advantages for anaesthesia and analgesia; however, they do increase the care requirements and workload for nursing staff, with increased risks for adverse events and errors or confusion. Perioperative nurses must be vigilant and thorough with nursing care and documentation in order to maintain high-quality, safe care ❤️.
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References:
Australian and New Zealand College of Anaesthetists. (2014). PG03(A) Guideline for the management of major regional analgesia. https://www.anzca.edu.au/getContentAsset/a70212ec-6074-4fa5-a62b-742f1f64523a/80feb437-d24d-46b8-a858-4a2a28b9b970/PG03%28A%29-Guideline-for-the-management-of-major-regional-analgesia-2014.PDF?language=en
South Eastern Sydney Local Health District. (2022). Pain Management — Peripheral Nerve Analgesia (PNA) Policy/Procedure (SESLHD PR-372). https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/SESLHDPR%20372%20-%20Pain%20Management%20-%20Peripheral%20Nerve%20Analgesia%20%28PNA%29.pdf
Western Australia Country Health Service. (2021). Regional Analgesia Management (Adult) Procedure. https://www.wacountry.health.wa.gov.au/~/media/WACHS/Documents/About-us/Policies/Regional-Analgesia-Management---Adult---Procedure.pdf
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