Nerve Block: Upper Extremity
Background
- Provides anesthesia 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 anesthetic
- Proximal vascular graft or AV fistula
Equipment Needed
- Chlorhexidine or betadine
- 5-10 mL Syringe
- 25-27 gauge needle
- Local anesthetic (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