Radial Nerve Block at Elbow

1. See Also
   1. Radial Nerve Block at Wrist
   2. Median Nerve Block
   3. Ulnar Nerve Block
   4. Regional Anesthesia (Nerve Block)
   5. Local Skin Anesthesia
   6. Field Block
   7. Hematoma Block
   8. Digital Block
   9. Point of Care Ultrasound (POCUS)
2. Indications
   1. Anesthesia of Radial Nerve distribution distal to elbow
3. Anatomy: Landmarks at Lateral Cubital Fossa
   1. Lateral Epicondyle
   2. Brachioradialis Insertion
   3. Radial Nerve
   4. Biceps Tendon
4. Precautions
   1. Avoid injecting directly into Radial Nerve
5. 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)
6. Technique
   1. Images
      1. 
      2. 
   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
7. References
   1. Yurgil (2020) Am Fam Physician 101(11):654-64 [PubMed]