Download Nerve Blocks

Upper Limb Nerve Blocks
Ulnar Nerve (Palmar Branch)
 Position
o Forearm supinated and wrist slightly flexed
 Technique
o Introduce the needle 1 to 2cm at right angles to the skin at the level of the ulnar styloid
between the ulnar artery and the tendon of flexor carpi ulnaris
o If parasthesia is elicited with draw slightly before injection
o If no parasthesia is elicited insert the needle to the deep fascia and inject
 Dose:
5 to 10ml 1% lignocaine
 Onset:
5 to 10 minutes
 Duration: 1.5 hours
Ulnar Nerve (Dorsal Branch)
 Position
o Forearm supinated and wrist slightly
flexed
 Technique
o Infiltrate subcutaneously at the level of
the ulnar styloid from the tendon of
flexor carpi ulnaris around the ulnar
aspect of the wrist
 Dose:
5ml 1% lignocaine
 Onset:
2 to 3 minutes
 Duration: 45 minutes
Median Nerve
 Position
o Forearm supinated and wrist slightly
flexed [aids identification of tendons]
 Technique
o Introduce the needle to a depth of 0.5 to
1cm at the level of the proximal skin
crease of the wrist between the tendons
of palmaris longus and flexor carpi
radialis
 Dose:
3 to 5 ml of 1 % lignocaine [in a
fan-shape distribution]
 Onset:
5 to 10 minutes
 Duration: 1.5 hours
Radial Nerve
 Position
o Forearm pronated
 Technique
o Infiltrate subcutaneously at
the level of the radial styloid
around the dorso-radial
aspect of the wrist
 Dose:
5 ml 1% lignocaine
 Onset:
2 to 3 minutes
Lower Limb Nerve Blocks
Tibial Nerve
 Position
o Patient prone with the ankle slightly dorsiflexed [supported on a pillow]
 Technique
o Insert the needle perpendicular to the posterior surface of the tibia, slightly lateral to the
posterior tibial artery at the level of the medial malleolus
o If the artery is not palpable insert the needle next to the Achilles tendon
 Dose:
5 to 10 ml 1% lignocaine [slowly withdraw by 1cm during injection]
 Onset:
5 to 10 minutes
 Duration: 1.5 hours
Sural Nerve Block
 Position
o Patient prone with the ankle slightly dorsiflexed
[supported on a pillow]
 Technique
o Infiltrate the subcutaneous tissue between the
Achilles tendon and the lateral malleolus
 Dose:
5 to 8 ml 1% lignocaine with adrenaline
 Onset:
2 to 3 minutes
 Duration: 1 hour
Superficial Peroneal Nerve Block
 Position
o Patient supine with the ankle plantar flexed
 Technique
o Infiltrate the subcutaneous tissue between the lat.
malleolus and the anterior border of the tibia
 Dose:
5 to 10 ml 1% lignocaine with adrenaline
 Onset
2 to 3 minutes
Duration
1 hour
Deep Peroneal Nerve Block
 Position
o Patient supine with the ankle slightly plantar
flexed
 Technique
o Palpate the dorsalis pedis artery and inject on
either side of it
 Dose:
4 to 6 ml 1% lignocaine with or without
adrenaline
 Onset:
5 to 10 minutes
 Duration: 1 hour
Saphenous Nerve Block
 Position
o Patient supine with the leg externally rotated at the
hip and flexed at the knee
 Technique
o Infiltrate subcutaneously one hand’s breadth
above the medial malleolus from the anterior
edge of the tibia medially around to the Achilles
tendon
 Dose:
5 to 10 ml 1% lignocaine with or without
adrenaline
 Onset:
2 minutes
 Duration: 1 hour