Elbow Block

Chapter 3 Elbow Block



Overview


The following five nerves are involved in an elbow block: radial, median, ulnar, medial antebrachial cutaneous, and lateral antebrachial cutaneous.


1. The radial and lateral antebrachial cutaneous nerves typically are blocked at the same time because of their proximity to one another.

2. The ulnar and medial antebrachial cutaneous nerves typically are blocked at the same time because of their proximity to one another.


Indications for use


A complete elbow block can be used when soft tissue procedures that cross dermatomal boundaries are performed.



Precautions


Intravascular and intranervous injection is of particular concern when injecting anesthetic around the elbow.



Pearls



1. The Median nerve lies Medial to the brachial artery.

2. To remember the order from lateral to medial, use the mnemonic “Break Right Through Both Military Police” for Brachioradialis, Radial nerve, biceps Tendon, Brachial artery, Median nerve, and Pronator teres.


Equipment



1. Antiseptic: Chlorhexidine prep stick or alcohol-soaked gauze

2. Syringe: 3 × 10 mL syringe

3. Needle:
a. Three large-bore, blunt-tipped, drawing-up needles

b. Three 1½-inch 25-gauge needles

4. Anesthetic:
a. Make sure that the dose of anesthetic is safe for the patient’s weight and health status.

b. Lidocaine: 15 mL of 1%

c. Bupivacaine: 15 mL of 0.5%
(1) Ulnar and medial antebracheal cutaneous nerves: 10 mL of anesthetic

(2) Median nerve: 5 mL of anesthetic

(3) Radial and lateral antebrachial cutaneous nerves: 10 mL of anesthetic

5. Sterile gloves

6. 4 × 4 inch gauze


Basic technique



1. Patient positioning: The patient should be seated and a bedside table should be available to position the extremity.
a. Ulnar nerve and medial antebrachial cutaneous nerve:
(1) Shoulder at 90 degrees of abduction and external rotation

(2) Elbow at 90 degrees of flexion

b. Median nerve:
(1) Shoulder at 45 degrees of abduction and maximal external rotation

(2) Elbow extended

c. Radial and lateral antebrachial cutaneous nerve:
(1) Shoulder at 45 degrees of abduction and maximal external rotation

(2) Elbow extended

2. Landmarks:
a. Ulnar and medial antebrachial cutaneous nerves:
(1) Medial epicondyle

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Aug 24, 2016 | Posted by in ORTHOPEDIC | Comments Off on Elbow Block

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