Ring Block, Epidurals, Fentanyl Patch

• onset:  < 5 minutes
• duration:  1 - 2 hours

• onset:  15 minutes
• duration:  4 - 6 hours

• radial nerve
• medial nerve
• ulnar nerve

• insert the needle and inject the local anesthetic as we pull out (fanning)
• insert the needle at each individual nerve and insert a small amount of anesthetic at each location

L6 to midsacrum and the wings of the ilia

• in sternal recumbency with the hind legs pulled forward
• in sternal recumbency with the hind legs pulled back into a frog leg position

• locate landmark
• insert needle at 60 degrees to the table
• slowly advance needle through the skin and remove stylet
• place a small bleb of saline or local anesthetic on the hub of the needle to create hanging drop
• hold the hub of the needle steady using both hands and slowly the advance the needle, it will pop through several ligament layers
• push firmly to advance needle into epidural space, the bleb on the needles hub will be drawn into the epidural space
• attach syringe and aspirate to confirm negative pressure
• the air bubble on the top of the fluid in the syringe should freely move with the fluid and should not compress or expand as you let off the plunger
• withdraw the syringe and needle and place finger over the hole

• infection
• trauma
• hemorrhage

patients with obvious skin infections or inflammation at the site of injection, coagulopathy patients, and patients that are hypotensive or at risk for hypotension

• onset:  12 hours
• duration:  3 days

• clip hair over application site in both directions
• wipe the area with DRY gauze
• remove adhesive back from the patch and gently lay the patch on the clipped area
• hold hand over the patch for 2 to 3 minutes
• write the date and time of application on patch

use adhesive spray remover or Avon Skin So Soft

no