Distal Upper Extremity Block

8 Distal Upper Extremity Block



Ulnar, Median, and Radial Block at the Elbow




Placement



At the Elbow



Anatomy


Of the three major nerves at the elbow—radial, median, and ulnar—the ulnar is most predictable in location. As illustrated in Figure 8-1, the ulnar nerve is located in the ulnar groove, which is a bony fascial canal between the medial epicondyle of the humerus and the olecranon process. This area is extremely well protected by fibrous tissue and, although it may seem at first like an easy site to carry out block, the nerve is well protected (and potentially vulnerable) in the ulnar groove. The median nerve at the elbow lies medial to the brachial artery, which lies just medial to the biceps muscle. Conversely, the radial nerve has a somewhat variable course; it pierces the lateral intramuscular septum on its way to the forearm, and lies between the brachialis muscle and the brachioradialis muscle in the distal aspect of the upper arm. It is more effectively blocked in the axilla than at the elbow.




May 31, 2016 | Posted by in ANESTHESIA | Comments Off on Distal Upper Extremity Block

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