Pharm
Median Nerve Block
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Median Nerve Block
, Regional Anesthesia of the Median Nerve, Median Nerve Block at Wrist
See Also
Median Nerve
Median Nerve Block at Elbow
Radial Nerve Block
Ulnar Nerve Block
Regional Anesthesia
(
Nerve Block
)
Local Skin Anesthesia
Field Block
Hematoma Block
Digital Block
Point of Care Ultrasound
(
POCUS
)
Indications
Anesthesia
of
Median Nerve
distribution distal to wrist
Consider in combination with
Ulnar Nerve Block at Wrist
and
Radial Nerve Block at Wrist
for
Complete Hand Anesthesia
See
Complete Hand Anesthesia
Contraindications (Relative)
Carpal Tunnel Syndrome
Precautions
Avoid
Median Nerve
Injection is harmful if improperly done
Anatomy
Relationships
Flexor carpi radialis (radial side)
Median Nerve
Palmaris Longus (Ulnar side)
Forms palmar aponeurosis at midline of wrist
Opose thumb and 5th finger to find palmaris longus
Preparation
Needle: 23 to 27 gauge 1.5 inch
Skin Preparation
(e.g.
Hibiclens
or
Betadine
)
See
Regional Anesthesia
Anesthetic
See
Regional Anesthesia
for
Anesthetic
options
Local
Anesthetic
2-5 ml (
Ultrasound
) or 5-10 ml (landmark)
Technique
Images
Wrist
position
Forearm
supinated
Dorsiflex wrist to 30 degrees resting on towel roll
Ultrasound
-Guidance (preferred)
High frequency linear probe in short axis
Start with probe over mid-
Forearm
Median Nerve
is "starry night" ovoid structure between flexor digitorum superficialis and profundus
Slide
Ultrasound
probe distally until a vessel is not adjacent to nerve
Ultrasound
-guided injection site will be proximal to landmark-guided injection
Use standard
Ultrasound
-guided
Regional Anesthesia
technique
Injection site
Proximal wrist crease AND
Radial side of following landmark
Wrist
midline (1 cm medial to flexor carpi radialis tendon) IF palmaris longus absent OR
Palmaris longus tendon
Find by opposing thumb with pinky or
Flex middle finger against resistance
Needle insertion
Apply antiseptic to skin (e.g.
Betadine
)
Aim 45 degrees distally toward middle and ring fingers
Some guidelines recommend directing needle proximally at 45 degrees
Insert needle 1-2 cm until no resistance
Do not inject if
Paresthesia
s (see below)
Warning: Distal
Paresthesia
s with needle with injection
Indicates needle is at
Median Nerve
Do not inject here!
Remove needle and replace further to the ulnar side
References
Eicken and Rempell (2016) Crit Dec Emerg Med 30(4):3-11
Pfenninger (1994) Procedures, Mosby, p. 1036-54
Salam (2004) Am Fam Physician 69(4):896 [PubMed]
Yurgil (2020) Am Fam Physician 101(11):654-64 [PubMed]
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