Nerve Block: Median
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 epi, 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 pt and laterality
- Apply topical anesthesia
- Draw up 5-10 mL of anesthetic into syringe
- Beware of toxic dose of anesthetic you're using Local Anesthetic Systemic Toxicity (LAST)
Wrist Block
Elbow Block
- Aspirate; if no blood inject a few mL's of anesthetic slowly
- Test sensation to pain distal to block
Complications
- Bleeding
- Infection
- Pain
- Needle fracture
- Neurapraxia
See Also
- Nerve Blocks (Main)
- Local Anesthetic Systemic Toxicity (LAST)
- Median and Ulnar Block
- Median Block at Elbow