II. Indications

  1. Anesthesia of Radial Nerve distribution distal to elbow

III. Anatomy: Landmarks at Lateral Cubital Fossa

  1. Lateral Epicondyle
  2. Brachioradialis Insertion
  3. Radial Nerve
  4. Biceps Tendon

IV. Precautions

  1. Avoid injecting directly into Radial Nerve

V. 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)

VI. Technique

  1. Images
    1. radialNerveBlockElbowLandmark.jpg
    2. radialNerveBlockElbowUltrasound.jpg
  2. Position
    1. Forearm pronated
    2. Elbow flexed to 90 degrees
  3. Injection site (Landmarks)
    1. Insert needle at lateral elbow 1-2 cm proximal to antecubital crease and at 45 degree angle
    2. Direct the needle between the brachioradialis muscle and the biceps tendon toward the Humerus
  4. Ultrasound-Guidance (preferred)
    1. High frequency linear probe in short axis
    2. Use standard Ultrasound-guided Regional Anesthesia technique
    3. Linear probe is transverse to Forearm, parallel to cubital fossa
    4. Injection site is approximately 3-4 cm distal to the lateral epicondyle
  5. Needle insertion
    1. Apply antiseptic to skin (e.g. Hibiclens or Betadine)
    2. Insert needle 1 cm until no resistance
    3. Do not inject if Paresthesias (see below)
  6. Warning: Distal Paresthesias with needle with injection
    1. Indicates needle is at Median Nerve
    2. Do not inject here!
    3. Remove needle and redirect

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