II. Indications

  1. Regional Anesthesia to allow for procedures (in place of Procedural Sedation)
  2. Severe localized pain control (e.g. Forearm Fracture)
    1. Consider Hematoma Block

III. Contraindications

V. Technique: Complete Hand Anesthesia (Wrist Block)

  1. Images
    1. forearmMedianUlnarNerveBlock.jpg
  2. Perform median and ulnar wrist blocks under Ultrasound guidance
    1. Forearm Median Nerve Block
    2. Forearm Ulnar Nerve Block
  3. Perform Field Block (non-Ultrasound guided) of the dorsolateral wrist
    1. Start lateral to radial artery near radial styloid
    2. Perform Subcutaneous Injection from radial styloid, across the dorsal wrist
      1. Follow standard Regional Anesthesia procedures to prevent complications (e.g. LAST Reaction)
    3. Alternative: Radial Nerve Block at Elbow (or mid-Forearm)
      1. Difficult to localize Radial Nerve branches on Wrist Ultrasound (branches at proximal wrist)
      2. Dorsolateral Field Block offers similar results due to superficial location of Radial Nerve branches
  4. References
    1. Wrist Block (Nysora, accessed 12/22/2020)
      1. https://www.nysora.com/techniques/upper-extremity/wrist/ultrasound-guided-wrist-block/

VI. Complications

  1. Nerve injury with persistent Paresthesias
  2. See Local Anesthetic System Toxicity (LAST)

VIII. References

  1. Eicken and Rempell (2016) Crit Dec Emerg Med 30(4):3-11
  2. Reardon and Martel (2020) Regional Anesthesia for Acute Care Conference, attended 12/11/2020
    1. https://stabroom.com/
  3. Swaminathan and Stone in Herbert (2019) EM:Rap 19(3): 3-4
  4. Yurgil (2020) Am Fam Physician 101(11):654-64 [PubMed]

Images: Related links to external sites (from Bing)

Related Studies