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Ulnar Nerve Block
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Ulnar Nerve Block
, Regional Anesthesia of the Ulnar Nerve, Ulnar Nerve Block at Wrist
See Also
Ulnar Nerve
Ulnar Nerve Block at Elbow
Median Nerve Block
Radial Nerve Block
Regional Anesthesia
(
Nerve Block
)
Local Skin Anesthesia
Field Block
Hematoma Block
Digital Block
Point of Care Ultrasound
(
POCUS
)
Indications
Anesthesia
of
Ulnar Nerve
distribution distal to wrist (medial hand)
Consider in combination with
Median Nerve Block at Wrist
and
Radial Nerve Block at Wrist
for
Complete Hand Anesthesia
See
Complete Hand Anesthesia
Contraindications
See
Regional Anesthesia
Anatomy
Landmarks at medial or ulnar wrist
Ulnar styloid (proximal) or
Pisiform Bone
(distal)
Flexor Carpi Ulnaris tendon (medial or ulnar aspect)
Palpate at region proximal to
Pisiform Bone
Better defined during wrist flexion
Ulnar Vein
Ulnar Nerve
Ulnar Artery (lateral or radial aspect)
Precautions
Avoid injecting directly into
Ulnar Nerve
Avoid injection into ulnar artery
Confirm adequate
Anesthesia
at palmar 4th and 5th fingers
Preparation
Needle: 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
Ultrasound
Guided (preferred)
Images
Position
Patient seated
Forearm
supinated (palm up)
Ultrasound
Probe Position
Transverse to
Forearm
, over the wrist crease
See Landmarks above
Injection
Insert needle at proximal palmar wrist crease
Direct needle from distal to proximal at 30 degree angle, perpendicular to probe (out-of-plane)
Technique
Landmark
Images
Position
Patient seated
Forearm
supinated (palm up)
Injection site 1: Palmar branch of the
Ulnar Nerve
(typical insertion site)
Direct needle from ulnar aspect of wrist towards radial wrist at 45 degree angle
Insert at proximal wrist crease (or 1-2 cm proximal), between flexor carpi ulnaris tendon and ulnar artery
Inject under flexor carpi ulnaris tendon
Advance needle deeper towards ulna and inject additional 3 ml of
Anesthetic
while withdrawing needle
Injection site 2: Dorsal branch of the
Ulnar Nerve
Distal aspect of ulnar styloid process (dorsum)
Infiltrate 3-4 ml subcutaneously
Warning: Distal
Paresthesia
s with needle with injection
Indicates needle is at
Ulnar Nerve
Do not inject here!
Remove needle and reposition
References
Pfenninger (1994) Procedures, Mosby, p. 1036-54
Warrington and Sanders (2018) Crit Dec Emerg Med 32(7): 41
Salam (2004) Am Fam Physician 69(4):896 [PubMed]
Yurgil (2020) Am Fam Physician 101(11):654-64 [PubMed]
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