Question: How can you minimize the risk of accidental intravascular injection of LA when performing the block?

Answer: To minimize the risk of accidental intravascular injection:

• Always aspirate prior to injection of LA. Aspiration of blood indicates intravascular placement of the block needle or catheter. Deliver LA in 3 - 5ml increments with aspiration between injections
• Consider the use of adrenaline to reduce systemic absorption of LA and as a marker of intravascular injection
• When available use ultrasound. Avoid large vessels and look for appropriate spread of LA. Absent spread on ultrasound raises suspicion of intravascular injection – if no spread is seen the needle tip must be repositioned