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NYSORA SIMULATORS™ are designed to facilitate ultrasound skill acquisition and retention. Each simulator includes relevant anatomy, allows for needle insertion and injection, and provides an in-depth, procedure-specific educational experience. NYSORA Ultrasound Simulators facilitate learning of anatomy, and they can also be used for testing knowledge acquisition and certification. One of the essential advantages of the SIMULATION is that the hand-eye coordination and needling technique can be practiced as many times as necessary. This is not possible or ethical in patients. The ultrasound and needle insertion skills can be learned before approaching patients, as well in practices in which there may not be enough patients for the training of all trainees. NYSORA SIMULATORS™ feature remarkably accurate essential anatomy, small footprint, and replaceable inserts. The instruction for use and information can be found on NYSORA.com. The labeled structures are designed for self-practice or learning in a group workshop session. Different models optimize the development of specific knowledge and skills using both landmark and ultrasound-guided procedural techniques.
Indications: Goal: Local anesthetic spread in the sub-Tenon’s, retrobulbar, or peribulbar space, respectively, for sub-Tenon’s, retrobulbar, and peribulbar eye blocks. Needle: 21-25-gauge Local anesthetic volume: 3-11 mL
Indications: Same as with traditional infraclavicular block – anesthesia and analgesia for the upper extremity, elbow, forearm and hand surgeries, and analgesia for shoulder procedures. Goal: Local anesthetic spread between the three cords of the brachial plexus Transducer: Linear Needle: 22 gauge, 5 cm short bevel Local anesthetic volume: 15-20 mL
The shoulder block is a selective block of the nerves innervating the shoulder: suprascapular and axillary nerves. It is an alternative analgesic technique to the interscalene or supraclavicular brachial plexus blocks that avoid the motor block of the arm and hand and the phrenic nerve (hemidiaphragmatic paresis). Indications: Analgesia of the shoulder in patients with respiratory compromise (i.e., patients who cannot tolerate >20% reduction in the forced vital capacity (FVC). Goal: Local anesthetic injection around the suprascapular and axillary nerves (or around the lateral and posterior cords of brachial plexus caudal to the clavicle). Transducer: Linear Needle: 5 cm (for supraclavicular approach); 5-8 cm (for suprascapular approach) Local anesthetic volume: 5-10 mL per nerve
Indications: Anesthesia and analgesia for forearm, hand and wrist procedures Goal: Injection of local anesthetic into the fascial planes enveloping the radial, median, and/or ulnar nerves. Transducer: Linear Needle: 25-gauge, short-bevel, insulated stimulating needle (optional) Local anesthetic volume: 3–5 mL per nerve
Indications: Brief surgical procedures or manipulations (< 1-hour duration) of the upper or lower extremity Goal: Injection of a local anesthetic solution into the venous system of an upper or lower extremity that has been exsanguinated by compression or gravity and that has been isolated from the central circulation using a tourniquet IV catheter: 22-gauge Local anesthetic volume: 30-50 mL for upper extremity (dependent on the size of the arm)Intravenous regional anesthesia (IVRA) or Bier block
Indications: Analgesia for rib fractures, back and chest wall surgeries. Goal: Injection of local anesthetic in the plane deep to the erector spinae muscles and superficial to the transverse processes, to achieve a craniocaudal distribution along several vertebral levels. Transducer: Linear or curved Needle: 22 gauge, 5-10 cm short bevel Local anesthetic volume: 20-30 mL
Indications: Postoperative analgesia for midline abdominal incisions (e.g., umbilical hernia repair, periumbilical surgeries). Goal: Injection of the local anesthetic posterior to the rectus muscle but anterior to the posterior rectus sheath to block the anterior cutaneous branches of the intercostal nerves. Transducer: Linear Needle: 50-100 mm, 22-gauge Local anesthetic volume: 10-15 mL
Indications: Analgesia after hip fractures or arthroplasty (especially through anterior approach). Goal: Local anesthetic spread in the plane between the iliopsoas muscle and pubic ramus, and anterior capsule of the hip cranially to the acetabular rim. This injection anesthetizes most of the nociceptive fibers to the hip joint capsule which emanate from the lumbar plexus. In addition, this injection may prevent or decrease the postoperative spasm of the iliacus muscle, which is a common cause of postoperative pain after anterior hip arthroplasty. Transducer: Curved (can use linear in smaller patients) Needle: 80-100 mm, 22 gauge Local anesthetic volume: 10-12 mL
Infiltration of the local anesthetic between the popliteal artery and capsule of the knee (IPACK).
Indications: Analgesia after knee arthroplasty, cruciate ligament repair, and procedures involving the posterior aspect of the knee.
Goal: Local anesthetic infiltration over the posterior aspect of the femur underneath the popliteal artery.
Transducer: Low-frequency curved or high-frequency linear transducer
Needle: 80-100 mm, 20-22 gauge, short-bevel, insulated stimulating needle
Local anesthetic volume: 15-20 mL
Indications: Specific anesthesia and analgesia in the respective territory of the tibial nerve Goal: Local anesthetic spread surrounding the tibial nerve Transducer: Linear Needle: 25-gauge, 1 1/4″ needle Local anesthetic volume: 5-8 mL
Indications: Specific anesthesia and analgesia in the respective territory of the deep peroneal nerve Goal: Local anesthetic spread surrounding the deep peroneal nerve Transducer: Linear Needle: 25-gauge, 1 1/4″ needle Local anesthetic volume: 3-5 mL
Indications: Specific anesthesia and analgesia in the respective territory of the superficial peroneal nerve Goal: Local anesthetic spread surrounding the superficial peroneal nerve Transducer: Linear Needle: 25-gauge, 1 1/4″ needle Local anesthetic volume: 3-5 mL
Indications: Specific anesthesia and analgesia in the respective territory of the sural nerve Goal: Local anesthetic spread surrounding the sural nerve Transducer: Linear Needle: 25-gauge, 1 1/4″ needle Local anesthetic volume: 3-5 mL
Indications: Specific anesthesia and analgesia in the respective territory of the saphenous nerve Goal: Local anesthetic spread surrounding the saphenous nerve Transducer: Linear Needle: 25-gauge, 1 1/4″ needle Local anesthetic volume: 3-5 mL
Indications: Anesthesia for surgery below the umbilicus, procedures on the lower extremities, perineum, pelvic girdle, urological, gynecological, obstetric, and lower abdominal and perineal surgery Goal: Local anesthetic spread in the subarachnoid space Transducer: Curved Needle: 25-gauge Local anesthetic volume: 1.5–3.5 mL 
Indications: Anesthesia for lower extremity, genitourinary, vascular, gynecologic, colorectal, and cardiothoracic surgery Goal: Local anesthetic spread in the epidural space Epidural needle: 17- or 18-gauge and 9 cm in length, with surface markings at 1 cm intervals Epidural catheter: 19-gauge paired with 17-gauge needle, or 20-gauge paired with 18-gauge needle Local anesthetic volume: 1-2 mL per segment to be blocked
NYSORA’s regional anesthesia and pain management protocols are standardized patient management pathways. These pathways can be reproduced or modified to developing individual institutions-specific pathways to standardize & improve quality and safety of perioperative management
NYSORA’s anesthesia protocols for orthopedic surgery are only intended to provide guidance and assistance to anesthesia professionals in order to improve and maintain the quality and safety of anesthesia care. Although the protocols are standardized, please keep in mind that some elements of patient care must be modified as seen fit, considering the distinct characteristics of the patient and the hospital resources available.
NYSORA’s regional anesthesia and pain management protocols are standardized patient management pathways. These pathways can be reproduced or modified to developing individual institutions-specific pathways to standardize & improve quality and safety of perioperative management.
NYSORA’s regional anesthesia and pain management protocols are standardized patient management pathways. These pathways can be reproduced or modified to developing individual institutions-specific pathways to standardize & improve quality and safety of perioperative management
Microscopic anatomy that emphasizes structure-function relations is important to the clinical practice of regional anesthesia. This course provides a basis for understanding the structure, classification, and organization of the peripheral nerves and insight into how the characteristics of the peripheral nerves relate to the clinical practice of regional anesthesia.
It is not uncommon that a perfectly performed intrathecal injection of local anesthetic in an attempt to accomplish spinal anesthesia fails in a busy clinical practice. Despite the reliability of the technique, the possibility of failure can never be eliminated. Managing a patient with an ineffective or inadequate spinal anesthetic can be challenging, and prevention is better than cure. Possible mechanisms of failure include the inability to reach the subarachnoid space, errors in drug preparation or injection, the unsatisfactory spread of the injectate within the cerebrospinal fluid (CSF), ineffective drug action on neural tissue, and difficulties related to patient expectations and psychology rather than genuine block failure. Note