Arm Regional Anesthesia

Aka: Arm Regional Anesthesia, Ultrasound Guided Regional Anesthesia of the Upper Extremity, Nerve Block of the Hand and Wrist, Hand and Wrist Regional Anesthesia, Ultrasound-Guided Wrist Block, Complete Hand Anesthesia, Wrist Nerve Block

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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

  1. See Regional Anesthesia

IV. Types: Arm

  1. Images
    1. neuroPeripheralArm.jpg
  2. Neck and upper chest
    1. Superficial Cervical Plexus Block (anterolateral neck and clavicle)
  3. Shoulder
    1. Superior Trunk Block
    2. Interscalene Brachial Plexus Block
    3. Suprascapular Nerve Block
    4. Axillary Nerve Block
  4. Upper arm and elbow
    1. Interscalene Brachial Plexus Block (includes Shoulder)
    2. Supraclavicular Brachial Plexus Block (entire arm distal to Shoulder)
  5. Forearm and hand
    1. Infraclavicular Brachial Plexus Block (includes elbow)
    2. Axillary Brachial Plexus Block
  6. Elbow
    1. Median Nerve Block at Elbow
    2. Radial Nerve Block at Elbow
    3. Ulnar Nerve Block at Elbow
  7. Wrist
    1. Median Nerve Block at Wrist
    2. Radial Nerve Block at Wrist
    3. Ulnar Nerve Block at Wrist

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)

VII. Resources

  1. Local Anesthetics: Clinical Pharmacology and Rational Selection (NYSORA)
    1. http://www.nysora.com/regional-anesthesia/foundations-of-ra/3492-local-anesthetics-clinical-pharmacology-and-rational-selection.html
  2. Upper Extremity Nerve Blocks (AAFP, Includes diagrams and videos)
    1. https://www.aafp.org/afp/2020/0601/p654.html

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]

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