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Upper Extremity Nerve Block: Difference between revisions
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{{Ported|source=[https://wikem.org/wiki/Nerve_Block:_Upper_Extremity WikiEM]|license=CC-BY-SA|license-link=https://creativecommons.org/licenses/by-sa/4.0/}} | {{Ported|source=[https://wikem.org/wiki/Nerve_Block:_Upper_Extremity WikiEM]|license=CC-BY-SA|license-link=https://creativecommons.org/licenses/by-sa/4.0/}} | ||
==Background== | ==Background== | ||
*Provides | *Provides anaesthesia in a larger area for wound exploration, irrigation, and repair without distorting local anatomy | ||
==Indications== | ==Indications== | ||
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==Contraindications== | ==Contraindications== | ||
*Infection overlying injection site | *Infection overlying injection site | ||
*Previous allergic reaction to | *Previous allergic reaction to anaesthetic | ||
*Proximal vascular graft or AV fistula | *Proximal vascular graft or AV fistula | ||
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*5-10 mL Syringe | *5-10 mL Syringe | ||
*25-27 gauge needle | *25-27 gauge needle | ||
*Local | *Local anaesthetic (lidocaine without epinephrine, bupivacaine) | ||
*Sterile gloves ย | *Sterile gloves ย | ||
*Sterile drape | *Sterile drape | ||
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*Position the patient in position of comfort, placing the arm on a Mayo stand | *Position the patient in position of comfort, placing the arm on a Mayo stand | ||
===For Median Nerve block=== | ===For [[Median Nerve Block|Median Nerve block]]=== | ||
#Locate the palmaris longus (PL) and the flexor carpi radialis (FCR) tendonsย ย | #Locate the palmaris longus (PL) and the flexor carpi radialis (FCR) tendonsย ย | ||
#you can have the patient flex the middle finger against resistance or pinch their thump and pinky together to help highlight these tendons | #you can have the patient flex the middle finger against resistance or pinch their thump and pinky together to help highlight these tendons | ||
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#allow anesthetic to sit ~10 minutes prior to performing procedure ย | #allow anesthetic to sit ~10 minutes prior to performing procedure ย | ||
===For Radial Nerve Block=== | ===For [[Radial Nerve Block]]=== | ||
#locate the radial styloid and prep and drape area sterily | #locate the radial styloid and prep and drape area sterily | ||
#inject 5cc of anethetic just above the radial styloid aiming medially | #inject 5cc of anethetic just above the radial styloid aiming medially | ||
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*Nerve injury | *Nerve injury | ||
*Vascular injury ย | *Vascular injury ย | ||
==References== | ==References== | ||
<References/> | <References/> |
Latest revision as of 21:40, 4 May 2022
Background
- Provides anaesthesia in a larger area for wound exploration, irrigation, and repair without distorting local anatomy
Indications
- Upper extremity fracture
- Serious trauma/injury or need to perform painful procedure in area covered by distribution of nerve to be blocked
Contraindications
- Infection overlying injection site
- Previous allergic reaction to anaesthetic
- Proximal vascular graft or AV fistula
Equipment Needed
- Chlorhexidine or betadine
- 5-10 mL Syringe
- 25-27 gauge needle
- Local anaesthetic (lidocaine without epinephrine, bupivacaine)
- Sterile gloves
- Sterile drape
Procedure
- Obtain informed consent
- Perform and document a thorough neurovascular examination of the extremity
- Draw up your anesthetic and load a 25-27 gauge needle
- Position the patient in position of comfort, placing the arm on a Mayo stand
For Median Nerve block
- Locate the palmaris longus (PL) and the flexor carpi radialis (FCR) tendons
- you can have the patient flex the middle finger against resistance or pinch their thump and pinky together to help highlight these tendons
- some patients do not have PL but you can estimate its general location by going 5 mm medially to the FCR (~midpoint of the wrist)
- Prep the skin and drape it in sterile fashion
- Insert the needle perpendicular to the skin between the PL and FCR tendons 2-3 cm proximal to the distal crease of the wrist to a depth of 1-2cm
- aspirate and then inject 3-5cc of anesthetic then remove needle
- allow anesthetic to sit ~10 minutes prior to performing procedure
For Radial Nerve Block
- locate the radial styloid and prep and drape area sterily
- inject 5cc of anethetic just above the radial styloid aiming medially
- extend infiltration laterally using an aditional 5cc of anesthetic
Complications
- Infection
- Hematoma
- Nerve injury
- Vascular injury