II. Indications
- Anesthesia of Median Nerve distribution distal to elbow
III. Precautions
- Avoid Median Nerve direct injection
- Injection is harmful if improperly done
IV. Anatomy: Relationships (cubital fossa at elbow)
- Biceps Tendon (lateral)
- Brachial artery
- Median Nerve
- Pronator Teres at humeral head (medial)
V. Preparation
- Needle: 27 gauge 1.5 inch
- Skin Preparation (e.g. Hibiclens or Betadine)
-
Anesthetic
- See Regional Anesthesia for Anesthetic options
- Local Anesthetic 2-5 ml (Ultrasound) or 5-10 ml (landmark)
VI. Technique: Elbow (Cubital Fossa)
- Images
-
Elbow position
- Forearm supinated, elbow resting, partially flexed
-
Ultrasound-Guidance (preferred)
- High frequency linear probe in short axis
- Use standard Ultrasound-guided Regional Anesthesia technique
- Linear probe is transverse to Forearm, in-line with the cubital fossa
- Injection site
- Inject 1 cm medial to palpable brachial artery
- Needle insertion
- Apply antiseptic to skin (e.g. Hibiclens or Betadine)
- Aim 30 degrees from medial to lateral elbow in line with antecubital crease
- Insert needle 1 cm until no resistance
- Do not inject if Paresthesias (see below)
- Warning: Distal Paresthesias with needle with injection
- Indicates needle is at Median Nerve
- Do not inject here!
- Remove needle and replace further to the ulnar side
