Difference between revisions of "Nerve Block: Median"

(Median block)
 
(links)
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*Time out, confirm correct pt and laterality
 
*Time out, confirm correct pt and laterality
 
*Apply topical anesthesia  
 
*Apply topical anesthesia  
*Draw up 5 mL of anesthetic into syringe
+
*Draw up 5-10 mL of anesthetic into syringe
 
**Beware of toxic dose of anesthetic you're using [[Local Anesthetic Systemic Toxicity (LAST)]]
 
**Beware of toxic dose of anesthetic you're using [[Local Anesthetic Systemic Toxicity (LAST)]]
 +
===Wrist Block===
 +
 +
===Elbow Block===
 +
  
 
*Aspirate; if no blood inject a few mL's of anesthetic slowly
 
*Aspirate; if no blood inject a few mL's of anesthetic slowly
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*[[Nerve Blocks (Main)]]
 
*[[Nerve Blocks (Main)]]
 
*[[Local Anesthetic Systemic Toxicity (LAST)]]
 
*[[Local Anesthetic Systemic Toxicity (LAST)]]
 +
*[https://www.youtube.com/watch?v=6NKkzs9FA5I Median and Ulnar Block]
 +
*[https://www.youtube.com/watch?v=2_ve-mNaYmI Median Block at Elbow]
  
 
==References==
 
==References==

Revision as of 07:38, 29 October 2015

Background

  • Useful for lacerations across multiple fingers/palm instead of multiple digit blocks
  • Useful for exploration of flexor tendons of digits 1-3
The yellow area indicates the area of the hand innervated by the median nerve

Indications

  • Trauma or need to perform painful procedure on area innervated by median nerve

Contraindications

  • Infection overlying injection site
  • Previous allergic reaction to local anesthesic used
  • Distortion of anatomic landmarks

Equipment Needed

  • Topical anesthesia (LET, EMLA)
  • local anesthesia
    • Lidocaine 1% (lasts 30-60 minutes or longer if given with epi, rapid onset)
    • Mepivacaine 3% (lasts 45-90 minutes, slower onset)
    • Bupivacaine 0.5% (lasts 2-4 hours, slowest in onset)
  • 18G needle to draw up anesthetic
  • 25-30G needle to inject
  • 10 cc syringe
  • Gauze pads

Procedure

Wrist Block

Elbow Block

  • Aspirate; if no blood inject a few mL's of anesthetic slowly
  • Test sensation to pain distal to block

Complications

  • Bleeding
  • Infection
  • Pain
  • Needle fracture
  • Neurapraxia

See Also

References