Nerve Block: Radial Nerve
Overview
- Effective method of regional pain control of the forearm.
Indications
- Surgical anesthesia along the course of the radial nerve
- Postoperative anesthesia
- Radial Tunnel Syndrome
- Cheiralgia paresthetica or Wartenberg Syndrome
Contraindications
- Infection at the site
- Severe coagulopathy
- Allergy to local anesthetic
Equipment Needed
- Alcohol/Betadine/Chlorhexidine
- Syringe, 1 mL, for local anesthetic
- Syringe, 5 mL, for nerve block
- Anesthetic - Lidocaine 1%/2%, bupivacaine 0.5%, or ropivacaine 0.5%
- Sterile Gloves
- Adhesive Bandage
Procedure
Block at humerus level
- Patient supine with arm abducted to 45 degrees and hand resting on abdomen
- Palpate deeply between the heads of the triceps muscle and brachialis muscle (musculospiral groove)
- Prepare skin with antiseptic solution
- Infiltrate injection site with 1mL of anesthetic
- Insert a 25-gauge perpendicularly toward the musculospiral groove
- Identify the nerve by parathesia
- Aspirate to ensure you are not intravascular
- Slowly inject anesthetic
Block at elbow level
- Patient supine with arm abducted to 45 degrees
- Flex the elbow and identify the lateral margin of the biceps tendon at the elbow crease
- Prepare skin with antiseptic solution
- Infiltrate injection site with 1mL of anesthetic
- Insert the needle just lateral to the tendon and advance slightly medial and cephalad towards the humerus
- Identify the nerve by parathesia
- Aspirate to ensure you are not intravascular
- Slowly inject anesthetic
Block at wrist level
- Prepare skin with antiseptic solution
- Infiltrate injection site with 1mL of anesthetic
- Insert needle just above radial styloid and aim medially
- Aspirate to ensure you are not intravascular
- Slowly inject anesthetic and extend the infiltration laterally
Ultrasound Guided
- Please see Highland EM U/S Guide for videos and tutorials
Complications
- Residual Paresthesia due to intraneuronal injection
- Systemic Toxicity due to intravascular injection
- Local Site infection
- Hematoma
See Also
Nerve and regional blocks (main)