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
Probe in antecubital fossa
Identify nerve medial to brachial artery
‘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.
Radial and ulnar infiltration
Avoid median due to tight compartment
Finger (ring) block
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.