Used 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

    Irrigation of deep abrasions with embedded debris

    Extensive or complex laceration repair

    Burn injury pain control

    Incision and drainage of abscess

    Fracture/dislocation reduction

    Traumatic amputation

CONTRAINDICATIONS

 Overlying cellulitis at site of anticipated injection

 Relative Contraindications

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

COMPLICATIONS

 Hematoma formation and/or vascular injury

 Nerve injury

 Infection

 Allergic reaction

ULNAR NERVE BLOCK

 Landmarks

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

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

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

 Technique

    Patient Preparation

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

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

       Have patient flex wrist against resistance to accentuate landmarks

       Identify 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)

    Injection

       Approach 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)

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

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

       To 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.

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

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