Nerve Block: Median: Difference between revisions
(Median block) |
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| Line 26: | Line 26: | ||
*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
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
- Time out, confirm correct pt and laterality
- Apply topical anesthesia
- Draw up 5-10 mL of anesthetic into syringe
- 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
- Test sensation to pain distal to block
Complications
- Bleeding
- Infection
- Pain
- Needle fracture
- Neurapraxia
See Also
- Nerve Blocks (Main)
- Local Anesthetic Systemic Toxicity (LAST)
- Median and Ulnar Block
- Median Block at Elbow