Upper limb peripheral nerve blocks

Radial

Probe in antecubical fossa

Identify nerve laterally

Scan proximally and laterally to identify nerve above the elbow

It wraps around the humerus posteriorly in the spiral groove between triceps and humerus.

Inject at a level between elbow and when nerve is against bone i.e. inject when the nerve is ‘off the bone’ rather than in a tight compartment

Median

Probe in antecubital fossa

Identify nerve medial to brachial artery

Ulnar

Flex elbow

‘Plonck’ the probe in belly of flexor muscles. Identify nerve as it leaves cubital tunnel of medial epicondyle of elbow.

Proximally the ulnar artery is deeper than the nerve. Distally the ulnar nerve runs adjacent to ulnar artery.

Wrist block

Radial and ulnar infiltration

Avoid median due to tight compartment

Finger (ring) block

Useful!

General

For wrist/forarm surgery a heavy, number arm for 12+ hours is undesirable so use shorter acting e.g. prilocaine

Peripheral nerve blocks useful for post-op pain, however will be painful when block wears off so must get analgesia on board

Cutaneous nerves for skin incision e.g. at site of distal radial fracture, come off fairly proximally so peripheral block will cover bony pain but surgical infiltration required to cover incision.