II. Indications

  1. Anesthesia of Median Nerve distribution distal to elbow

III. Precautions

  1. Avoid Median Nerve direct injection
  2. Injection is harmful if improperly done

IV. Anatomy: Relationships (cubital fossa at elbow)

  1. Biceps Tendon (lateral)
  2. Brachial artery
  3. Median Nerve
  4. Pronator Teres at humeral head (medial)

V. Preparation

  1. Needle: 27 gauge 1.5 inch
  2. Skin preparation (e.g. Hibiclens or Betadine)
    1. See Regional Anesthesia
  3. Anesthetic
    1. See Regional Anesthesia for Anesthetic options
    2. Local Anesthetic 2-5 ml (Ultrasound) or 5-10 ml (landmark)

VI. Technique

  1. Images
    1. medianNerveBlockElbowLandmark.jpg
    2. medianNerveBlockElbowUltrasound.jpg
  2. Elbow position
    1. Forearm supinated, elbow resting, partially flexed
  3. Ultrasound-Guidance (preferred)
    1. High frequency linear probe in short axis
    2. Use standard Ultrasound-guided Regional Anesthesia technique
    3. Linear probe is transverse to Forearm, in-line with the cubital fossa
  4. Injection site
    1. Inject 1 cm medial to palpable brachial artery
  5. Needle insertion
    1. Apply antiseptic to skin (e.g. Hibiclens or Betadine)
    2. Aim 30 degrees from medial to lateral elbow in line with antecubital crease
    3. Insert needle 1 cm until no resistance
    4. Do not inject if Paresthesias (see below)
  6. Warning: Distal Paresthesias with needle with injection
    1. Indicates needle is at Median Nerve
    2. Do not inject here!
    3. Remove needle and replace further to the ulnar side

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