01/31/2025
One of the frequent discussion topics at all of the Twin Oaks Anesthesia Services block courses is the controversy over sterility.
There have been several formal investigations and many peer reviewed published articles that nudge readers into the illusion that common peripheral nerve blocks should be performed under sterile conditions.
Let us set the record straight. Single shot perform nerve blocks should be done under common sense aseptic technique.
There is very little data suggesting significant increase in favorable outcomes with the addition of sterile technique to single shot nerve blocks such as interscalene, brachial, plexus, femoral, popliteal, etc. We were able to locate one such article that made a statement that block should be performed under strict sterile technique, but, the authors provided no evidence to support this claim. One such tactic to nudge readers into the illusion of sterility is to conveniently group peripheral nerve blocks as central. This is also deceiving.
Another aspect that the literature is quite clear on, is an increase in time required to produce sterility, and increases in cost per block- when efforts are made to unnecessarily make single shot blocks sterile.
Conclusion: Single shot common peripheral nerve blocks should be performed with common sense measures to protect both patients and equipment. These should include the use of a sterile probe cover (although the procedure itself is not sterile), single use sterile gel (because the alternative of using a multi use gel bottle may be contaminated gel), and non-sterile gloves. Draping for single shot perform blocks has zero evidence to produce beneficial outcome yet consistently yields increases in time and cost.
Allowing skin preparation to dry prior to performing single shot. Peripheral nerve blocks is also sensible, not necessarily due to the risk of infection, but the introduction of skin preparation solution directly to the nerve, which may lead to neurotoxicity.
