Wrist Nerve Blocks

imagesUsed to provide anesthesia in distribution of median, ulnar, and/or radial nerves for the treatment of complex soft-tissue or bony injuries of the hand


   imagesIrrigation of deep abrasions with embedded debris


   imagesExtensive or complex laceration repair


   imagesBurn injury pain control


   imagesIncision and drainage of abscess


   imagesFracture/dislocation reduction


   imagesTraumatic amputation


CONTRAINDICATIONS



imagesOverlying cellulitis at site of anticipated injection


imagesRelative Contraindications


   imagesSimple laceration or injury that can be easily and adequately anesthetized with local infiltration or digital block


COMPLICATIONS



imagesHematoma formation and/or vascular injury


imagesNerve injury


imagesInfection


imagesAllergic reaction



imagesGeneral Basic Steps


   imagesPalpate landmarks


   imagesSterile prep of skin


   imagesInject anesthetic


   imagesConsider sensory branches


ULNAR NERVE BLOCK



imagesLandmarks


   imagesFlexor carpi ulnaris tendon, pisiform bone, ulnar artery, proximal wrist crease (FIGURE 82.1)


   imagesUlnar nerve splits into dorsal and palmar branches approximately 5 cm proximal to the wrist crease


   imagesPalmar branch runs between the flexor carpi ulnaris tendon and the ulnar artery at the level of the proximal wrist crease


imagesTechnique


   imagesPatient Preparation


      imagesPlace the hand comfortably on bedside procedure table with palmar surface up


      imagesPrepare wrist site in standard sterile manner (povidone–iodine solution or chlorhexidine)


      imagesHave patient flex wrist against resistance to accentuate landmarks


      imagesIdentify and mark the flexor carpi ulnaris tendon from its insertion site at the pisiform bone to the ulnar nerve branch point (approximately 5 cm proximal to wrist crease)



images


FIGURE 82.1 Surface anatomy of the wrist region. (From Snell RS. Clinical Anatomy. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:534, with permission.)


   imagesInjection


      imagesApproach the wrist medially and insert a small-bore (25-gauge) needle beneath the flexor carpi ulnaris tendon at the level of the proximal wrist crease (FIGURE 82.2)


        imagesInject approximately 2 mL of anesthetic solution (lidocaine/bupivacaine) beneath the tendon at its radial border


        imagesAspirate before injecting anesthetic to ensure that ulnar artery has not been inadvertently entered


      imagesTo anesthetize the dorsal branch of the ulnar nerve use the same initial insertion site and technique. However, redirect needle 3 to 5 cm proximally toward the branch point.


        imagesInject approximately 5 mL of anesthetic solution beneath the tendon at this branch point



images


FIGURE 82.2 Injection site of an ulnar nerve block.

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Wrist Nerve Blocks

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