Nerve Block: Median: Difference between revisions
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==See Also== | ==See Also== | ||
*[[Nerve | *[[Nerve blocks (main)]] | ||
*[[Local | *[[Local anesthetic systemic toxicity]] | ||
*[ | |||
*[ | ==External Links== | ||
*[https://www.youtube.com/watch?v=2_ve-mNaYmI Median Block at Elbow] | *[http://emedicine.medscape.com/article/1369028-overview#a1 Emedicine: Median Wrist Block] | ||
*[https://www.youtube.com/watch?v=6NKkzs9FA5I Video: Median and Ulnar Block] | |||
*[https://www.youtube.com/watch?v=2_ve-mNaYmI Video: Median Block at Elbow] | |||
==References== | ==References== |
Revision as of 00:26, 25 December 2016
Background
- Useful for lacerations across multiple fingers/palm instead of multiple digit blocks
- Useful for exploration of flexor tendons of digits 1-3
Indications
- Trauma or need to perform painful procedure on area innervated by median nerve
Contraindications
- Infection overlying injection site
- Previous allergic reaction to local anesthesic used
- Distortion of anatomic landmarks
Equipment Needed
- Topical anesthesia (LET, EMLA)
- local anesthesia
- Lidocaine 1% (lasts 30-60 minutes or longer if given with epinephrine, rapid onset)
- Mepivacaine 3% (lasts 45-90 minutes, slower onset)
- Bupivacaine 0.5% (lasts 2-4 hours, slowest in onset)
- 18G needle to draw up anesthetic
- 25-30G needle to inject
- 10 cc syringe
- Gauze pads
Procedure
- Time out, confirm correct patient and laterality
- Apply topical anesthesia if needed
- Draw up 5-10 mL of anesthetic into syringe
- Beware of toxic dose of anesthetic you're using Local Anesthetic Systemic Toxicity (LAST)
- Before any nerve block, perform neurovascular exam (often includes 2 patient discrimination with paperclip)
Wrist Block
- Median nerve is within the carpal tunnel
- Between palmaris longus and flexor carpi radialis
- Insert needle perpendicular between tendons, 2-3 cm proximal to the distal crease of the wrist
- Aspirate; if no blood inject a few mL's of anesthetic slowly
- Test sensation to pain distal to block
Elbow Block
Complications
- Bleeding
- Infection
- Pain
- Needle fracture
- Neurapraxia