Distal and peripheral nerve blocks
Oct 30, 2025
Straight to the point: Distal & Peripheral Nerve Blocks
Distal and peripheral nerve blocks provide precise, targeted analgesia for procedures on the extremities, such as hands, wrists, feet or ankles. These small blocks offer targeted pain relief to a small area, minimising the wider spread sensory and motor block that can occur with larger blocks. These blocks involve injecting local anaesthetic around a specific peripheral nerve or nerves supplying a small part of the limb, thereby enabling effective analgesia or anaesthesia for minor surgery, traumatic injury or postoperative pain.
Common examples in the perioperative setting include:
🔹 Digital/ring blocks
- these target the dorsal web-space branches, volar subcutaneous nerves or a circumferential (three or four-sided) ring infiltration around a digit (finger or toe) for lacerations, simple injuries or minor procedures
🔹 Wrist blocks
- involve blockade of the radial, median and ulnar nerves at the level of the wrist (sometimes supplemented by posterior or anterior interosseous nerve branches) for hand, wrist or forearm surgery or analgesia.
🔹 Ankle/foot blocks
- Typically the ankle block involves five separate nerve injections (posterior tibial, deep peroneal, superficial peroneal, sural and saphenous nerves) at or near the ankle to provide analgesia for foot/ankle surgery or trauma
Key care elements are similar to any other regional block, including: ensuring accurate documentation of block type, limb and side; establishing baseline sensory and motor assessment of the limb; monitoring for block onset, efficacy and resolution; vigilance for complications such as local anaesthetic systemic toxicity (LAST), nerve injury, haematoma, infection or delayed recovery of function; and planning ongoing analgesia when the block wears off.
Distal and peripheral nerve blocks are valuable, less-invasive tools in the perioperative analgesia toolbox, particularly for extremity surgery or trauma. For perioperative nurses, awareness of their indications, anatomical targets, expected timelines and monitoring imperatives is essential for optimising patient comfort and safety.
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References
Corvetto, M. A., Echevarria, G. C., Espinoza, A. M., et al. (2015). Which types of peripheral nerve blocks should be included in residency training programs? BMC Anesthesiology, 15, 32. https://doi.org/10.1186/s12871-015-0001-4 BioMed Central
Hazmenzedeh, S., & Bravos, E. D. (2019, August 7). Peripheral nerve blocks of the distal upper extremity. ASRA Blog. Retrieved from https://asra.com/news-publications/legacy-b-blog-posts/2019/08/07/peripheral-nerve-blocks-of-the-distal-upper-extremity ASRA Pain Medicine
Jeng, C. L., Rosenblatt, M. A., Maniker, R., Nussmeier, N. (2025, July). Overview of peripheral nerve blocks. UpToDate. Retrieved from https://www.uptodate.com/contents/overview-of-peripheral-nerve-blocks UpToDate
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