Morning Report: 12/16/2014

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.

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
The following two tabs change content below.

Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital

Latest posts by Jay Khadpe MD (see all)