Distal Upper Extremity Nerve Blocks Flashcards
What are some indication for a distal nerve block?
Fingernail removal
Wound debridement
Small wound closure
Supplement inadequate brachial plexus block
What are the three distal nerves?
Ulnar
Median
Radial
What areas does the ulnar nerve supply?
The pinky finger and half of the ring finger
What areas does the median nerve supply?
Supplies the middle finger and part of the index finger
What areas does the radial nerve supply?
Back of the hand, part of the thumb and up the arm
What landmarks do you use to locate the median artery?
Medial to brachial artery, line between medial and lateral epicondyles
How much LA is injected into a median nerve block?
3-5mL
What are the landmarks for a radial nerve block?
Groove between brachioradialis muscle and biceps tendon
How should the needle be directed for a radial nerve block?
Proximally and laterally
What is the motor response with radial nerve stimulation?
Wrist extension
Metacarpo-phalangeal extension
Thumb abduction
Why is it dangerous to try to pick off the ulnar nerve separately?
Danger of forming a neuroma
What is the distribution of the ulnar nerve?
Pinky finger and half of the ring finger
Where is the needle insertion for an ulnar nerve block?
Along longitudinal axis
How much LA should be injected into the ulnar nerve?
3-5mL
If the provider would like to anesthetize the wrist, where would the needle insertion be for the median nerve?
Between palmaris longs and flexor carpi radialis
Where is the radial nerve located if the provider is performing a wrist block?
Subcutaneous on the extensor aspect of lower arm at the wrist
How is the radial nerve blocked for a wrist procedure?
Subcutaneous ring 5-7mL LA, styloid process to flexor carpi radialis
What are the two branches of the ulnar nerve?
Dorsal branch: sensory
Palmar branchL Mixed
Where is the ulnar nerve located?
Between flexor carpi ulmaris and ulnar artery
Where is the insertion point for an ulnar nerve block at the wrist?
Insert lateral to ulnar artery 3-5mL
What types of blocks should never contain epi?
Penis, nose, fingers and toes
What can occur if too much LA is injected in a digital block?
Can compress the arteries and restrict blood supply
How much LA should be administered in a digital block?
2-3mL per side
What are complications of a digital block?
Hematoma
Gangrene of the digits
Nerve injury
What size needle should be used to avoid a digital hematoma?
25 gauge or less
