View source for Nerve block: upper extremity

==Background==
*Provides anesthesia in a larger area for wound exploration, irrigation, and repair without distorting local anatomy

==Indications==
*Upper extremity fracture
*Serious trauma/injury or need to perform painful procedure in area covered by distribution of nerve to be blocked

==Contraindications==
*Infection overlying injection site
*Previous allergic reaction to anesthetic 
*Proximal vascular graft or AV fistula

==Equipment Needed==
*Chlorhexidine or betadine
*5-10 mL Syringe
*25-27 gauge needle
*Local anesthetic (lidocaine without epinephrine, bupivacaine) 
*Sterile gloves 
*Sterile drape

==Procedure==
*Obtain informed consent
*Perform and document a thorough neurovascular examination of the extremity 
*Draw up your anesthetic and load a 25-27 gauge needle 
*Position the patient in position of comfort, placing the arm on a Mayo stand

===For Median Nerve block===
#Locate the palmaris longus (PL) and the flexor carpi radialis (FCR) tendons  
#you can have the patient flex the middle finger against resistance or pinch their thump and pinky together to help highlight these tendons
#some patients do not have PL but you can estimate its general location by going 5 mm medially to the FCR (~midpoint of the wrist)
#Prep the skin and drape it in sterile fashion 
#Insert the needle perpendicular to the skin between the PL and FCR tendons 2-3 cm proximal to the distal crease of the wrist to a depth of 1-2cm
#aspirate and then inject 3-5cc of anesthetic then remove needle
#allow anesthetic to sit ~10 minutes prior to performing procedure 

===For Radial Nerve Block===
#locate the radial styloid and prep and drape area sterily
#inject 5cc of anethetic just above the radial styloid aiming medially
#extend infiltration laterally using an aditional 5cc of anesthetic

==Complications==
*Infection
*Hematoma
*Nerve injury
*Vascular injury 

==See Also==
*[[Nerve blocks (main)]]
*[[Local anesthetic systemic toxicity]]
 
==References==
<References/>

[[Category:Procedures]]
[[Category:Orthopedics]]