Nerve Block: Ulnar Nerve: Difference between revisions
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==Background== | ==Background== | ||
* | *Ulnar nerve block is a quick, safe, and effective means of pain reduction for hand injuries, including reduction of [[Boxer's Fracture]]<ref>Ünlüer, EE. Ultrasound-guided Ulnar Nerve Block For Boxers Fractures. Am.J.Emerg.Med. 2016;34(8):1726.</ref> | ||
==Indications== | ==Indications== | ||
* [[Boxer's Fracture]] | *[[Boxer's Fracture]] | ||
* [[Burns|Hand Burns]] | *[[Burns|Hand Burns]] | ||
* [[Hand and finger tendon injuries|Complex Hand Injury]] | *[[Hand and finger tendon injuries|Complex Hand Injury]] | ||
*Need for pain control or to perform painful procedure in distribution of ulnar nerve | |||
==Contraindications== | ==Contraindications== | ||
* | *Infection overlying injection site | ||
==Equipment Needed== | ==Equipment Needed== | ||
* 10 cc Syringe with a 27 Gauge Needle | *10 cc Syringe with a 27 Gauge Needle | ||
* | *Blunt fill needle (to draw up anesthetic) | ||
* Local Anesthetic (e.g. [[Lidocaine]] | *Local Anesthetic (e.g. [[Lidocaine]] or [[Bupivacaine]]) | ||
* Antiseptic (e.g. Chlorhexidine, Betadine | *Antiseptic (e.g. Chlorhexidine, Betadine) | ||
* Sterile Gloves | *Sterile Gloves | ||
* Sterile Drape | *Sterile Drape and sterile ultrasound probe cover | ||
* Linear Ultrasound Probe | *Linear Ultrasound Probe | ||
==Procedure== | ==Procedure== | ||
[[File:Blind_Ulnar_Nerve_Block.jpg|thumb|Ulnar Nerve Block at the Wrist]] | |||
* | [[File:Ultrasound_Ulnar_Nerve.png|thumb|Ulnar Nerve at the Distal Wrist]] | ||
* Place the patient's extremity in the supinated position | [[File:Ulnar_Nerve_US_Probe.png|thumb|Following the Ulnar Nerve Distally]] | ||
* Cleanse the skin with chosen antiseptic | |||
* Create a sterile field using | *Obtain informed consent | ||
* In a sterile fashion, apply a small wheel of local anesthetic to the area immediately | **Patient should be made aware that they will lose both sensory and motor function of the ulnar distribution until the anesthetic wears off | ||
* The ulnar nerve should be immediately deep to the Flexor Carpi Ulnaris Tendon | *Place the patient's extremity in the supinated position | ||
*Cleanse the skin with chosen antiseptic | |||
*Create a sterile field using sterile drape | |||
*In a sterile fashion, apply a small wheel of local anesthetic to the area immediately medial to tendon of the Flexor Carpi Ulnaris and approximately 2 cm proximal to the wrist crease. | |||
*The ulnar nerve should be immediately deep to the Flexor Carpi Ulnaris Tendon | |||
===Non-Ultrasound Guided Technique=== | ===Non-Ultrasound Guided Technique=== | ||
*Direct the Needle radially, deep to the Flexor Carpi Ulnaris | |||
* Direct the Needle radially, deep to the Flexor Carpi Ulnaris | *The ulnar nerve is ulnar in relation to the ulnar artery; even still, it is important to aspirate prior to injecting anesthetic to rule out intra-arterial placement | ||
* The ulnar nerve is ulnar in relation to the ulnar artery; even still, it is important to aspirate prior to injecting anesthetic to rule out intra-arterial placement | *Discontinue and reposition should the patient report shooting "electrical" pains or numbness prior to injection | ||
* Discontinue and reposition should the patient report shooting "electrical" pains or numbness prior to injection | *Inject approximately 5 mL of local anesthetic | ||
* Inject approximately 5 mL of local anesthetic | |||
===Ultrasound Guided Technique=== | ===Ultrasound Guided Technique=== | ||
*Have a partner help place the Linear Ultrasound Probe into the Sterile Probe Cover | |||
*Starting mid forearm of the volar aspect in a transverse plane, locate the Ulnar Nerve | |||
* Have a partner help place the Linear Ultrasound Probe into the Sterile Probe Cover | *Sliding Distally, the Ulnar Nerve and Artery should separate from each other | ||
* Starting mid forearm of the volar aspect in a transverse plane, locate the Ulnar Nerve | *Injection site is generally approximately 2 cm proximal to the wrist crease. | ||
* Sliding Distally, the Ulnar Nerve and Artery should separate from each other | *In plane, visualize the needle on the Ultrasound monitor as you advance towards the Ulnar Nerve. | ||
* Injection site is generally approximately 2 cm proximal to the wrist crease. | *Make sure to aspirate prior to injecting to rule out vascular penetration (low risk given ultrasound guidance) | ||
* In plane, visualize the needle on the Ultrasound monitor as you advance towards the Ulnar Nerve. | *Discontinue and reposition should the patient report shooting "electrical" pains or numbness prior to injection | ||
* Make sure to aspirate prior to injecting to rule out vascular penetration (low risk given ultrasound guidance) | *Inject approximately 5 mL of local anesthetic in the area immediately surrounding the Ulnar Nerve | ||
* Discontinue and reposition should the patient report shooting "electrical" pains or numbness prior to injection | |||
* Inject approximately 5 mL of local anesthetic in the area immediately surrounding the Ulnar Nerve | |||
==Complications== | ==Complications== | ||
* Inadvertent intravascular injection | *Inadvertent intravascular injection | ||
* Infection | *Infection | ||
* Bleeding/hematoma | *Bleeding/hematoma | ||
* Neurapraxia | *Neurapraxia | ||
==See Also== | ==See Also== | ||
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[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:Ultrasound]] | |||
Revision as of 18:08, 3 February 2017
Background
- Ulnar nerve block is a quick, safe, and effective means of pain reduction for hand injuries, including reduction of Boxer's Fracture[1]
Indications
- Boxer's Fracture
- Hand Burns
- Complex Hand Injury
- Need for pain control or to perform painful procedure in distribution of ulnar nerve
Contraindications
- Infection overlying injection site
Equipment Needed
- 10 cc Syringe with a 27 Gauge Needle
- Blunt fill needle (to draw up anesthetic)
- Local Anesthetic (e.g. Lidocaine or Bupivacaine)
- Antiseptic (e.g. Chlorhexidine, Betadine)
- Sterile Gloves
- Sterile Drape and sterile ultrasound probe cover
- Linear Ultrasound Probe
Procedure
- Obtain informed consent
- Patient should be made aware that they will lose both sensory and motor function of the ulnar distribution until the anesthetic wears off
- Place the patient's extremity in the supinated position
- Cleanse the skin with chosen antiseptic
- Create a sterile field using sterile drape
- In a sterile fashion, apply a small wheel of local anesthetic to the area immediately medial to tendon of the Flexor Carpi Ulnaris and approximately 2 cm proximal to the wrist crease.
- The ulnar nerve should be immediately deep to the Flexor Carpi Ulnaris Tendon
Non-Ultrasound Guided Technique
- Direct the Needle radially, deep to the Flexor Carpi Ulnaris
- The ulnar nerve is ulnar in relation to the ulnar artery; even still, it is important to aspirate prior to injecting anesthetic to rule out intra-arterial placement
- Discontinue and reposition should the patient report shooting "electrical" pains or numbness prior to injection
- Inject approximately 5 mL of local anesthetic
Ultrasound Guided Technique
- Have a partner help place the Linear Ultrasound Probe into the Sterile Probe Cover
- Starting mid forearm of the volar aspect in a transverse plane, locate the Ulnar Nerve
- Sliding Distally, the Ulnar Nerve and Artery should separate from each other
- Injection site is generally approximately 2 cm proximal to the wrist crease.
- In plane, visualize the needle on the Ultrasound monitor as you advance towards the Ulnar Nerve.
- Make sure to aspirate prior to injecting to rule out vascular penetration (low risk given ultrasound guidance)
- Discontinue and reposition should the patient report shooting "electrical" pains or numbness prior to injection
- Inject approximately 5 mL of local anesthetic in the area immediately surrounding the Ulnar Nerve
Complications
- Inadvertent intravascular injection
- Infection
- Bleeding/hematoma
- Neurapraxia
See Also
References
- ↑ Ünlüer, EE. Ultrasound-guided Ulnar Nerve Block For Boxers Fractures. Am.J.Emerg.Med. 2016;34(8):1726.