II. Indications
- Anesthesia of Radial Nerve distribution distal to wrist
- Consider in combination with Ulnar Nerve Block at Wrist and Median Nerve Block at Wrist for Complete Hand Anesthesia
III. Precautions
- Avoid injecting directly into Radial Nerve
- Avoid injection into radial artery
IV. 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)
V. Technique: Superficial Field Block (Landmark Block, preferred)
- Dorsolateral Wrist Block
- Start lateral to radial artery near radial styloid
- Perform Subcutaneous Injection from radial styloid, across the dorsal wrist
- Follow standard Regional Anesthesia procedures to prevent complications (e.g. LAST Reaction)
- Alternative: Radial Nerve Block at Elbow (or mid-Forearm)
- Difficult to localize Radial Nerve branches on Wrist Ultrasound (branches at proximal wrist)
- Dorsolateral Field Block offers similar results due to superficial location of Radial Nerve branches
- References
- Wrist Block (Nysora, accessed 12/22/2020)
VI. Technique: Ultrasound-Guided
- Precautions
- Often difficult to localize Radial Nerve branches at wrist
- Consider superficial Field Block (see above) or Radial Nerve Block at Elbow
- Images
- Position
- Wrist and hand resting on the ulnar aspect with the thumb upwards
-
Ultrasound Probe
- Linear Probe transverse to Forearm over the radial aspect, 2 cm proximal to the radial styloid
- Injection
- Direct the needle towards proximal Forearm
- Inject into the perineural space
VII. Technique: Landmarks
- Images
- Position
- Wrist and hand resting on the ulnar aspect with the thumb upwards
- Insertion site
- Insert needle 1-2 cm proximal and lateral to radial styloid
- Direct needle at 10-20 degree angle distally toward thumb
- Inject into subcutaneous tissue
- Warning: Distal Paresthesias with needle with injection
- Indicates needle is at Radial Nerve
- Do not inject here!
- Remove needle and reposition
VIII. References
- Pfenninger (1994) Procedures, Mosby, p. 1036-54
- Salam (2004) Am Fam Physician 69(4):896 [PubMed]
- Yurgil (2020) Am Fam Physician 101(11):654-64 [PubMed]
