II. Indications
- Anesthesia of Radial Nerve distribution distal to elbow
III. Anatomy: Landmarks at Lateral Cubital Fossa
- Lateral Epicondyle
- Brachioradialis Insertion
- Radial Nerve
- Biceps Tendon
IV. Precautions
- Avoid injecting directly into Radial Nerve
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
- Images
- Position
- Injection site (Landmarks)
-
Ultrasound-Guidance (preferred)
- High frequency linear probe in short axis
- Use standard Ultrasound-guided Regional Anesthesia technique
- Linear probe is transverse to Forearm, parallel to cubital fossa
- Injection site is approximately 3-4 cm distal to the lateral epicondyle
- Needle insertion
- Apply antiseptic to skin (e.g. Hibiclens or Betadine)
- 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 redirect
