Nerve block: median - Revision history

Danbot: Danbot moved page Nerve Block: Median to Nerve block: median without leaving a redirect: Naming convention: first word capitalized, subsequent words lowercase

2026-03-22T05:33:09Z

Danbot moved page Nerve Block: Median to Nerve block: median without leaving a redirect: Naming convention: first word capitalized, subsequent words lowercase

← Older revision	Revision as of 05:33, 22 March 2026
(No difference)

Blsimpso: /* Procedure */

2023-07-26T13:56:22Z

Procedure

← Older revision		Revision as of 13:56, 26 July 2023
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	*Draw up 5-10 mL of anesthetic into syringe		*Draw up 5-10 mL of anesthetic into syringe
	**Beware of toxic dose of anesthetic you're using [[Local Anesthetic Systemic Toxicity (LAST)]]		**Beware of toxic dose of anesthetic you're using [[Local Anesthetic Systemic Toxicity (LAST)]]
	*Before any nerve block, perform neurovascular exam (often includes 2 ~~patient~~ discrimination with paperclip)		*Before any nerve block, perform neurovascular exam (often includes 2 point discrimination with paperclip)
	===Wrist Block===		===Wrist Block===
	*Median nerve is within the carpal tunnel		*Median nerve is within the carpal tunnel

Bobzmac at 15:03, 3 February 2018

2018-02-03T15:03:23Z

← Older revision		Revision as of 15:03, 3 February 2018
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	*Inject 5-10 mL of local anesthetic		*Inject 5-10 mL of local anesthetic
	===Ultrasound Guided Block===		===Ultrasound Guided Block===
			[[File:Median Nerve Block Riscinti.gif\|thumbnail\|Ultrasound-guided median nerve block<ref>http://www.thepocusatlas.com/musculoskeletal/</ref>]]
	*Place a linear probe on the volar aspect of the midforearm		*Place a linear probe on the volar aspect of the midforearm
	**It may be easier to find the nerve by starting with the probe over the volar wrist and sliding proximally. The tendons will disappear as they become muscles but the nerve will remain as the only continuous round structure.		**It may be easier to find the nerve by starting with the probe over the volar wrist and sliding proximally. The tendons will disappear as they become muscles but the nerve will remain as the only continuous round structure.

Jdiamond: /* Ultrasound Guided Block */

2017-05-08T21:03:48Z

Ultrasound Guided Block

← Older revision		Revision as of 21:03, 8 May 2017
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	===Ultrasound Guided Block===		===Ultrasound Guided Block===
	*Place a linear probe on the volar aspect of the midforearm		*Place a linear probe on the volar aspect of the midforearm
			**It may be easier to find the nerve by starting with the probe over the volar wrist and sliding proximally. The tendons will disappear as they become muscles but the nerve will remain as the only continuous round structure.
	*The median nerve takes the appearnce of a "chocolate chip cookie" in the axial orientation and lies between the flexor digitorum profundus and supeficialis		*The median nerve takes the appearnce of a "chocolate chip cookie" in the axial orientation and lies between the flexor digitorum profundus and supeficialis
	*Clean and prep the patient's arm under sterile conditions, and insert a 25 g needle in the long axis under ultrasound guidance next to the nerve		*Clean and prep the patient's arm under sterile conditions, and insert a 25 g needle in the long axis under ultrasound guidance next to the nerve

Jdiamond: /* Equipment Needed */

2017-05-08T21:02:17Z

Equipment Needed

← Older revision		Revision as of 21:02, 8 May 2017
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	*10 cc syringe		*10 cc syringe
	*Gauze pads		*Gauze pads
			*ultrasound probe cover or tegaderm to cover probe surface

	==Procedure==		==Procedure==

Jdiamond: /* Equipment Needed */

2017-05-08T20:59:41Z

Equipment Needed

← Older revision		Revision as of 20:59, 8 May 2017
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	**Bupivacaine 0.5% (lasts 2-4 hours, slowest in onset)		**Bupivacaine 0.5% (lasts 2-4 hours, slowest in onset)
	*18G needle to draw up anesthetic		*18G needle to draw up anesthetic
	*25-30G needle to inject		*25-30G needle to inject. Use of a larger gauge (21-23) makes it easier to see the needle on ultrasound
	*10 cc syringe		*10 cc syringe
	*Gauze pads		*Gauze pads

	==Procedure==		==Procedure==
	[[File:Medianblock.jpg\|200px\|thumbnail\|Median nerve lies between palmaris longus and flexor carpi radialis.]]		[[File:Medianblock.jpg\|200px\|thumbnail\|Median nerve lies between palmaris longus and flexor carpi radialis.]]

TJYE: /* Procedure */

2017-04-09T03:17:30Z

Procedure

← Older revision		Revision as of 03:17, 9 April 2017
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	*At 1-2 cm deep, aspirate prior to injection to rule out intravascular placement		*At 1-2 cm deep, aspirate prior to injection to rule out intravascular placement
	*Inject 5-10 mL of local anesthetic		*Inject 5-10 mL of local anesthetic
			===Ultrasound Guided Block===
			*Place a linear probe on the volar aspect of the midforearm
			*The median nerve takes the appearnce of a "chocolate chip cookie" in the axial orientation and lies between the flexor digitorum profundus and supeficialis
			*Clean and prep the patient's arm under sterile conditions, and insert a 25 g needle in the long axis under ultrasound guidance next to the nerve
			*Aspirate to prevent inadvertent intravascular injection
			*Inject 5 mL of local anesthetic so that it basks the nerve

	==Complications==		==Complications==
	*Bleeding		*Bleeding

TJYE: /* Background */

2017-04-09T03:12:11Z

Background

← Older revision		Revision as of 03:12, 9 April 2017
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	*Useful for lacerations across multiple fingers/palm instead of multiple digit blocks		*Useful for lacerations across multiple fingers/palm instead of multiple digit blocks
	*Useful for exploration of flexor tendons of digits 1-3		*Useful for exploration of flexor tendons of digits 1-3
	*Ultrasound guidance significantly increases the success rate of this block		*Ultrasound guidance significantly increases the success rate of this block <ref> Liebmann O, Price D, et al. [Feasibility of Forearm Ultrasonography-Guided Nerve Blocks of the Radial, Ulnar, and Median Nerves for Hand Procedures in the
			Emergency Department]. Ann Emerg Med 2006; 48(5):558-62.</ref>
	[[File:Handnerves.png\|thumbnail\|The yellow area indicates the area of the hand innervated by the median nerve]]		[[File:Handnerves.png\|thumbnail\|The yellow area indicates the area of the hand innervated by the median nerve]]

TJYE: /* Background */

2017-04-09T03:07:04Z

Background

← Older revision		Revision as of 03:07, 9 April 2017
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	*Useful for lacerations across multiple fingers/palm instead of multiple digit blocks		*Useful for lacerations across multiple fingers/palm instead of multiple digit blocks
	*Useful for exploration of flexor tendons of digits 1-3		*Useful for exploration of flexor tendons of digits 1-3
			*Ultrasound guidance significantly increases the success rate of this block
	[[File:Handnerves.png\|thumbnail\|The yellow area indicates the area of the hand innervated by the median nerve]]		[[File:Handnerves.png\|thumbnail\|The yellow area indicates the area of the hand innervated by the median nerve]]

Devin Smith: placed elbow instructions and another image

2017-02-19T23:08:32Z

placed elbow instructions and another image

← Older revision		Revision as of 23:08, 19 February 2017
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	==Procedure==		==Procedure==
			[[File:Medianblock.jpg\|200px\|thumbnail\|Median nerve lies between palmaris longus and flexor carpi radialis.]]
	*Time out, confirm correct patient and laterality		*Time out, confirm correct patient and laterality
	*Apply topical anesthesia if needed		*Apply topical anesthesia if needed
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	*Before any nerve block, perform neurovascular exam (often includes 2 patient discrimination with paperclip)		*Before any nerve block, perform neurovascular exam (often includes 2 patient discrimination with paperclip)
	===Wrist Block===		===Wrist Block===
	~~[[File:Medianblock.jpg\|thumbnail\|Median nerve lies between palmaris longus and flexor carpi radialis.]]~~
	*Median nerve is within the carpal tunnel		*Median nerve is within the carpal tunnel
	*Between palmaris longus and flexor carpi radialis		*Between palmaris longus and flexor carpi radialis
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	*Test sensation to pain distal to block		*Test sensation to pain distal to block
	===Elbow Block===		===Elbow Block===
			[[File:Nerves of the left upper extremity.gif\|thumb\|200px\|Upper Extremity Nerves]]
			*Cleanse the skin overlying the antecubital fossa with chosen antiseptic
			*Create a sterile field using sterile drape
			*In a sterile fashion, apply a small wheel of local anesthetic to the area immediately proximal to the antecubital fossa
			*Palpate the brachial artery to be aware of its path
			**The median nerve should be approximately 1 cm medial to the brachial artery at this point
			*Insert the needle approximately 1-2 cm proximal to the flexor crease and advance with negative pressure applied to the syringe
			*At 1-2 cm deep, aspirate prior to injection to rule out intravascular placement
			*Inject 5-10 mL of local anesthetic
	==Complications==		==Complications==
	*Bleeding		*Bleeding