Radial Nerve Block

Overview

• Effective method of regional pain control of the forearm.

Indications

• Surgical anesthesia along the course of the radial nerve
• Postoperative anesthesia
• Radial Tunnel Syndrome
• Cheiralgia paresthetica or Wartenberg Syndrome

Contraindications

• Infection at the site
• Severe coagulopathy
• Allergy to local anesthetic

Equipment Needed

• Alcohol/Betadine/Chlorhexidine
• Syringe, 1 mL, for local anesthetic
• Syringe, 5 mL, for nerve block
• Anesthetic - Lidocaine 1%/2%, bupivacaine 0.5%, or ropivacaine 0.5%
• Sterile Gloves
• Adhesive Bandage

Procedure

Block at humerus level

1. Patient supine with arm abducted to 45 degrees and hand resting on abdomen
2. Palpate deeply between the heads of the triceps muscle and brachialis muscle (musculospiral groove)
3. Prepare skin with antiseptic solution
4. Infiltrate injection site with 1mL of anesthetic
5. Insert a 25-gauge perpendicularly toward the musculospiral groove
6. Identify the nerve by parathesia
7. Aspirate to ensure you are not intravascular
8. Slowly inject anesthetic

Block at elbow level

1. Patient supine with arm abducted to 45 degrees
2. Flex the elbow and identify the lateral margin of the biceps tendon at the elbow crease
3. Prepare skin with antiseptic solution
4. Infiltrate injection site with 1mL of anesthetic
5. Insert the needle just lateral to the tendon and advance slightly medial and cephalad towards the humerus
6. Identify the nerve by parathesia
7. Aspirate to ensure you are not intravascular
8. Slowly inject anesthetic

Block at wrist level

1. Prepare skin with antiseptic solution
2. Infiltrate injection site with 1mL of anesthetic
3. Insert needle just above radial styloid and aim medially
4. Aspirate to ensure you are not intravascular
5. Slowly inject anesthetic and extend the infiltration laterally

Ultrasound Guided

• Please see Highland EM U/S Guide for videos and tutorials

Complications

• Residual Paresthesia due to intraneuronal injection
• Systemic Toxicity due to intravascular injection
• Local Site infection
• Hematoma