Major plexus blocks

analgesia blocks regionalanaesthesia Oct 23, 2025

Regional Control: The Role of Major Plexus Blocks 🌿

Major plexus blocks are peripheral regional anaesthetic techniques that target a specific nerve plexus (a group or bundle of nerves) to provide surgical anaesthesia and/or postoperative analgesia to a large limb or body region.

Common major plexus blocks include:
🔹 Brachial plexus (interscalene, supraclavicular, infraclavicular, axillary)
🔹 Lumbar plexus
🔹 Sacral/sciatic plexus

What are the benefits? ❤️
Plexus blocks are an excellent form of opioid-sparing analgesia, they enable ambulatory or day procedure surgery, and can improve early mobilisation and respiratory function compared with general anaesthesia alone. Continuous catheter techniques also extend analgesia into the postoperative period for major joint and limb surgery.

Technique practice points 🏥
🔸 Ultrasound guidance combined with nerve stimulation is standard practice to visualise anatomy, reduce needle passes, and improve block success.
🔸 Blocks may be single-shot, or use perineural catheters for continuous infusion.
🔸 Strict site marking, “stop before you block” checks, aseptic technique, and clear documentation are essential to avoid wrong-site/side blocks and infection.

Nursing considerations 📑
Complications can include:

  • Inadvertent vascular puncture
  • Local anaesthetic systemic toxicity (LAST)
  • Pneumothorax (supraclavicular/interscalene)
  • Nerve injury
  • Prolonged motor block
  • Catheter migration or dislodgement
    Infection
  • Compartment syndrome masking

Perioperative nurses should perform baseline neurovascular observations once the patient reaches recovery, with regular ongoing reassessment. If perineural catheters have been inserted, the infusion must be checked and commenced, and the catheter site regularly monitored. As with all local anaesthetic use, observe for signs of LAST, and implement precautions for limb protection given the ongoing sensory and motor blockade.

Any new or worsening neurological deficits, severe pain out of proportion, or signs of systemic toxicity should be escalated as a priority. Ongoing monitoring and documentation, patient education about block duration and limb protection, and clear handover to ward teams are critical to safe care and early detection of complications.

Build Knowledge ✅
Improve Safety ✅

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&view=1

British Journal of Anaesthesia. (2023). Peripheral regional anaesthesia and outcomes: a narrative review. https://www.bjanaesthesia.org/article/S0007-0912(23)00056-7/fulltext

Queensland Health. (2024). Stop before you block guide. https://www.health.qld.gov.au/__data/assets/pdf_file/0027/1438245/stop-before-you-block-guide-communique.pdf

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