Ulnar Nerve Block at Elbow

1. See Also
   1. Ulnar Nerve Block at Wrist
   2. Median Nerve Block
   3. Radial 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 Ulnar Nerve distribution distal to elbow
3. Precautions
   1. Avoid injecting directly into Ulnar Nerve
4. Anatomy: Landmarks
   1. Medial Epicondyle
   2. Ulnar Nerve
   3. Olecranon
5. Preparation
   1. Needle: 27 gauge 1.5 inch
   2. Anesthetic
      1. See Regional Anesthesia for Anesthetic options
      2. Local Anesthetic 2-5 ml (Ultrasound) or 5-10 ml (landmark)
   3. Skin Preparation (e.g. Hibiclens or Betadine)
      1. See Regional Anesthesia
   4. Position
      1. Patient supine
      2. Arm abducted 90 degrees, resting against table
      3. Flex elbow to 90 degrees
      4. Supinate Forearm
6. Technique: Ultrasound-Guided (Preferred)
   1. Images
      1. 
   2. Position patient as above
   3. Ultrasound probe
      1. Transverse to Forearm at level of medial epicondyle
   4. Injection
      1. Advance needle in-plane to Ultrasound probe
7. Technique: Landmark
   1. Images
      1. 
   2. Higher risk procedure due to risk of Ulnar Nerve injury
   3. Position patient as above
   4. Injection
      1. Insert needle between olecranon and medial epicondyle
      2. Direct needle distally at 30 degree angle
      3. Advance needle 0.5 cm deep
      4. Remain superficial to ulnar groove to avoid entering the Ulnar Nerve
      5. Inject 3-5 ml of Anesthetic
8. References
   1. Pfenninger (1994) Procedures, Mosby, p. 1036-54
   2. Warrington and Sanders (2018) Crit Dec Emerg Med 32(7): 41
   3. Salam (2004) Am Fam Physician 69(4):896 [PubMed]
   4. Yurgil (2020) Am Fam Physician 101(11):654-64 [PubMed]