Here’s Dr. LoCascio with today’s Morning Report!
Landmark Guided Wrist Blocks
Ultrasound guided blocks are great but we can’t forget how to do it based on landmarks.
Median Block
Locate the space between flexor palmaris logus and flexor carpi radialis. Insert the needle in this space between the proximal and distal wrist crease. Some sources recommend inserting the needle until you hit bone and then withdrawing 2-3 mm, some say to insert the needle until the patient has parasthesias and then to withdraw and inject. About 3 mls of lidocaine should be enough and it is probably better to use lido without epi since you are injecting close to vasculature.
Radial Block
The radial block is slightly more difficult because the position of the nerve varies and its multiple small branches. Locate the radial styloid and inject 5 mls of lidocaine just proximal to the styloid aiming medially, then redirect the needle laterally and inject another 5 mls.
Ulnar Block
Locate flexor carpi ulnaris just distal to the ulnar styloid and inject 3 mls of anesthetic using a lateral approach.
ALWAYS ASPIRATE BEFORE INJECTING LIDOCAINE WHEN PERFORMING ANY BLOCK TO ENSURE YOU ARE NOT INJECTING INTO A VESSEL.
For pictures and videos check out www.nysora.com the website for the New York School of Regional Anesthesia.
Jay Khadpe MD
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