Pharm

Arm Regional Anesthesia

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Arm Regional Anesthesia, Ultrasound Guided Regional Anesthesia of the Upper Extremity, Nerve Block of the Hand and Wrist, Hand and Wrist Regional Anesthesia, Ultrasound-Guided Wrist Block, Complete Hand Anesthesia, Wrist Nerve Block

  • Indications
  1. Regional Anesthesia to allow for procedures (in place of Procedural Sedation)
  2. Severe localized pain control (e.g. Forearm Fracture)
    1. Consider Hematoma Block
  • Contraindications
  • Technique
  • Complete Hand Anesthesia (Wrist Block)
  1. Perform median and ulnar wrist blocks under Ultrasound guidance
    1. Median Nerve Block at Wrist
    2. Ulnar Nerve Block at Wrist
  2. Perform Field Block (non-Ultrasound guided) of the dorsolateral wrist
    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/
  • Complications
  1. Nerve injury with persistent Paresthesias
  2. See Local Anesthetic System Toxicity (LAST)
  • References
  1. Eicken and Rempell (2016) Crit Dec Emerg Med 30(4):3-11
  2. Reardon and Martel (2020) Regional Anesthesia for Acute Care Conference, attended 12/11/2020
    1. https://stabroom.com/
  3. Swaminathan and Stone in Herbert (2019) EM:Rap 19(3): 3-4
  4. Yurgil (2020) Am Fam Physician 101(11):654-64 [PubMed]