II. Indications

  1. Anesthesia of Radial Nerve distribution distal to wrist

III. Precautions

  1. Avoid injecting directly into Radial Nerve
  2. Avoid injection into radial artery

IV. 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)

V. Technique: Ultrasound-Guided (preferred)

  1. Images
    1. radialNerveBlockWristUltrasound.jpg
  2. Position
    1. Wrist and hand resting on the ulnar aspect with the thumb upwards
  3. Ultrasound Probe
    1. Linear Probe transverse to Forearm over the radial aspect, 2 cm proximal to the radial styloid
  4. Injection
    1. Direct the needle towards proximal Forearm
    2. Inject into the perineural space

VI. Technique: Landmarks

  1. Images
    1. radialNerveBlockWristLandmark.jpg
  2. Position
    1. Wrist and hand resting on the ulnar aspect with the thumb upwards
  3. Insertion site
    1. Insert needle 1-2 cm proximal and lateral to radial styloid
    2. Direct needle at 10-20 degree angle distally toward thumb
    3. Inject into subcutaneous tissue
  4. Warning: Distal Paresthesias with needle with injection
    1. Indicates needle is at Radial Nerve
    2. Do not inject here!
    3. Remove needle and reposition

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