Radial Nerve Block

Aka: Radial Nerve Block, Regional Anesthesia of the Radial Nerve, Radial Nerve Block at Wrist

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II. Indications

  1. Anesthesia of Radial Nerve distribution distal to wrist
  2. Consider in combination with Ulnar Nerve Block at Wrist and Median Nerve Block at Wrist for Complete Hand Anesthesia
    1. See Complete Hand Anesthesia

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: Superficial Field Block (Landmark Block, preferred)

  1. Often combined with Forearm Median Nerve Block and Forearm Ulnar Nerve Block
  2. Dorsolateral Wrist Block
    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
  3. References
    1. Wrist Block (Nysora, accessed 12/22/2020)
      1. https://www.nysora.com/techniques/upper-extremity/wrist/ultrasound-guided-wrist-block/

VI. Technique: Ultrasound-Guided

  1. Precautions
    1. Often difficult to localize Radial Nerve branches at wrist
    2. Consider superficial Field Block (see above) or Radial Nerve Block at Elbow
  2. Images
    1. radialNerveBlockWristUltrasound.jpg
  3. Position
    1. Wrist and hand resting on the ulnar aspect with the thumb upwards
  4. Ultrasound Probe
    1. Linear Probe transverse to Forearm over the radial aspect, 2 cm proximal to the radial styloid
  5. Injection
    1. Direct the needle towards proximal Forearm
    2. Inject into the perineural space

VII. 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

VIII. References

  1. Pfenninger (1994) Procedures, Mosby, p. 1036-54
  2. Salam (2004) Am Fam Physician 69(4):896 [PubMed]
  3. Yurgil (2020) Am Fam Physician 101(11):654-64 [PubMed]

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