Distal Upper Extremity Nerve Blocks

Question 1

What are some indication for a distal nerve block?

Answer 1

Fingernail removal
Wound debridement
Small wound closure
Supplement inadequate brachial plexus block

Question 2

What are the three distal nerves?

Answer 2

Ulnar
Median
Radial

Question 3

What areas does the ulnar nerve supply?

Answer 3

The pinky finger and half of the ring finger

Question 4

What areas does the median nerve supply?

Answer 4

Supplies the middle finger and part of the index finger

Question 5

What areas does the radial nerve supply?

Answer 5

Back of the hand, part of the thumb and up the arm

Question 6

What landmarks do you use to locate the median artery?

Answer 6

Medial to brachial artery, line between medial and lateral epicondyles

Question 7

How much LA is injected into a median nerve block?

Answer 7

3-5mL

Question 8

What are the landmarks for a radial nerve block?

Answer 8

Groove between brachioradialis muscle and biceps tendon

Question 9

How should the needle be directed for a radial nerve block?

Answer 9

Proximally and laterally

Question 10

What is the motor response with radial nerve stimulation?

Answer 10

Wrist extension
Metacarpo-phalangeal extension
Thumb abduction

Question 11

Why is it dangerous to try to pick off the ulnar nerve separately?

Answer 11

Danger of forming a neuroma

Question 12

What is the distribution of the ulnar nerve?

Answer 12

Pinky finger and half of the ring finger

Question 13

Where is the needle insertion for an ulnar nerve block?

Answer 13

Along longitudinal axis

Question 14

How much LA should be injected into the ulnar nerve?

Answer 14

3-5mL

Question 15

If the provider would like to anesthetize the wrist, where would the needle insertion be for the median nerve?

Answer 15

Between palmaris longs and flexor carpi radialis

Question 16

Where is the radial nerve located if the provider is performing a wrist block?

Answer 16

Subcutaneous on the extensor aspect of lower arm at the wrist

Question 17

How is the radial nerve blocked for a wrist procedure?

Answer 17

Subcutaneous ring 5-7mL LA, styloid process to flexor carpi radialis

Question 18

What are the two branches of the ulnar nerve?

Answer 18

Dorsal branch: sensory

Palmar branchL Mixed

Question 19

Where is the ulnar nerve located?

Answer 19

Between flexor carpi ulmaris and ulnar artery

Question 20

Where is the insertion point for an ulnar nerve block at the wrist?

Answer 20

Insert lateral to ulnar artery 3-5mL

Question 21

What types of blocks should never contain epi?

Answer 21

Penis, nose, fingers and toes

Question 22

What can occur if too much LA is injected in a digital block?

Answer 22

Can compress the arteries and restrict blood supply

Question 23

How much LA should be administered in a digital block?

Answer 23

2-3mL per side

Question 24

What are complications of a digital block?

Answer 24

Hematoma
Gangrene of the digits
Nerve injury

Question 25

What size needle should be used to avoid a digital hematoma?

Answer 25

25 gauge or less