Nerve Block: Ulnar Nerve: Difference between revisions
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==Procedure== | ==Procedure== | ||
* Discuss the procedure with the patient regarding desired effects and potential complications | * Discuss the procedure with the patient regarding desired effects and potential complications | ||
* They should be made aware that they will lose both sensory and motor function of the ulnar distribution until the anesthetic wears off | * They should be made aware that they will lose both sensory and motor function of the ulnar distribution until the anesthetic wears off | ||
| Line 28: | Line 27: | ||
* Cleanse the skin with chosen antiseptic | * Cleanse the skin with chosen antiseptic | ||
* Create a sterile field using your sterile drape | * Create a sterile field using your sterile drape | ||
* In a sterile fashion, apply a small wheel of local anesthetic to the area immediately ulnar to tendon of the Flexor Carpi Ulnaris approximately 2 cm proximal to the wrist crease. | * In a sterile fashion, apply a small wheel of local anesthetic to the area immediately ulnar to tendon of the Flexor Carpi Ulnaris approximately 2 cm proximal to the wrist crease. | ||
* The ulnar nerve should be immediately deep to the Flexor Carpi Ulnaris Tendon | * The ulnar nerve should be immediately deep to the Flexor Carpi Ulnaris Tendon | ||
===Non-Ultrasound Guided Technique=== | |||
[[File:Blind_Ulnar_Nerve_Block.jpg|thumb|Ulnar Nerve Block at the Wrist]] | |||
* Direct the Needle radially, deep to the Flexor Carpi Ulnaris | * Direct the Needle radially, deep to the Flexor Carpi Ulnaris | ||
* The ulnar nerve is ulnar in relation to the ulnar artery; even still, it is important to aspirate prior to injecting anesthetic to rule out intra-arterial placement | * The ulnar nerve is ulnar in relation to the ulnar artery; even still, it is important to aspirate prior to injecting anesthetic to rule out intra-arterial placement | ||
* Discontinue and reposition should the patient report shooting "electrical" pains or numbness prior to injection | |||
* Inject approximately 5 mL of local anesthetic | * Inject approximately 5 mL of local anesthetic | ||
===Ultrasound Guided Technique=== | ===Ultrasound Guided Technique=== | ||
[[File:Ultrasound_Ulnar_Nerve.png|thumb|Ulnar Nerve at the Distal Wrist]] | |||
[[File:Ulnar_Nerve_US_Probe.png|thumb|Following the Ulnar Nerve Distally]] | |||
* Have a partner help place the Linear Ultrasound Probe into the Sterile Probe Cover | |||
* Starting mid forearm of the volar aspect in a transverse plane, locate the Ulnar Nerve | |||
* Sliding Distally, the Ulnar Nerve and Artery should separate from each other | |||
* Injection site is generally approximately 2 cm proximal to the wrist crease. | |||
* In plane, visualize the needle on the Ultrasound monitor as you advance towards the Ulnar Nerve. | |||
* Make sure to aspirate prior to injecting to rule out vascular penetration (low risk given ultrasound guidance) | |||
* Discontinue and reposition should the patient report shooting "electrical" pains or numbness prior to injection | |||
* Inject approximately 5 mL of local anesthetic in the area immediately surrounding the Ulnar Nerve | |||
==Complications== | ==Complications== | ||
Revision as of 05:27, 28 January 2017
Background
- This has been found to be a quick, safe, and effective means of pain reduction for hand injuries, including reduction of Boxer's Fracture. [1]
Indications
Contraindications
- Overlying site infection
- Injury requiring close neurologic observation (e.g. Compartment Syndrome)
Equipment Needed
- 10 cc Syringe with a 27 Gauge Needle
- Spare 18 Gauge Needle (to draw up anesthetic)
- Local Anesthetic (e.g. Lidocaine vs Bupivacaine)
- Antiseptic (e.g. Chlorhexidine, Betadine, Rubbing Alcohol)
- Sterile Gloves
- Sterile Drape
- Linear Ultrasound Probe (for ultrasound guided procedure)
- Sterile Ultrasound Prove Cover (for ultrasound guided procedure)
Procedure
- Discuss the procedure with the patient regarding desired effects and potential complications
- They should be made aware that they will lose both sensory and motor function of the ulnar distribution until the anesthetic wears off
- Place the patient's extremity in the supinated position
- Cleanse the skin with chosen antiseptic
- Create a sterile field using your sterile drape
- In a sterile fashion, apply a small wheel of local anesthetic to the area immediately ulnar to tendon of the Flexor Carpi Ulnaris approximately 2 cm proximal to the wrist crease.
- The ulnar nerve should be immediately deep to the Flexor Carpi Ulnaris Tendon
Non-Ultrasound Guided Technique
- Direct the Needle radially, deep to the Flexor Carpi Ulnaris
- The ulnar nerve is ulnar in relation to the ulnar artery; even still, it is important to aspirate prior to injecting anesthetic to rule out intra-arterial placement
- Discontinue and reposition should the patient report shooting "electrical" pains or numbness prior to injection
- Inject approximately 5 mL of local anesthetic
Ultrasound Guided Technique
- Have a partner help place the Linear Ultrasound Probe into the Sterile Probe Cover
- Starting mid forearm of the volar aspect in a transverse plane, locate the Ulnar Nerve
- Sliding Distally, the Ulnar Nerve and Artery should separate from each other
- Injection site is generally approximately 2 cm proximal to the wrist crease.
- In plane, visualize the needle on the Ultrasound monitor as you advance towards the Ulnar Nerve.
- Make sure to aspirate prior to injecting to rule out vascular penetration (low risk given ultrasound guidance)
- Discontinue and reposition should the patient report shooting "electrical" pains or numbness prior to injection
- Inject approximately 5 mL of local anesthetic in the area immediately surrounding the Ulnar Nerve
Complications
- Inadvertent intravascular injection
- Infection
- Bleeding/hematoma
- Neurapraxia
See Also
References
- ↑ Ünlüer, EE. Ultrasound-guided Ulnar Nerve Block For Boxers Fractures. Am. J. Emerg. Med. 2016; 34 (8): 1726.