Clinical scenario: A 21 yo M with no significant PMH presents to the ED with multiple lacerations of the right hand. Patient reports that he had an argument with his girlfriend over the phone and punched a mirror at home. His right hand is bleeding and the patient is complaining of pain everywhere in the hand. Aside from the potential foreign body in his lacerations, you ask yourself “how would I be able to control his pain to repair these lacerations?”
NERVE BLOCK! Nerve blocks in the forearm of the median nerve, radial nerve, and ulnar nerve are great at providing anesthesia to the hand. Know their distributions so that your block works for your patient’s indication. With the ultrasound, locate the nerves at the wrist and follow them proximally along the forearm; the ulnar and radial nerves branch away from their corresponding arteries when you move proximally. Inject your anesthetic of choice around the nerve and observe for pain relief!
[Purple is Median Nerve, Yellow is Radial Nerve, and Red is Ulnar Nerve. Image from http://www.acepnow.com/article/perform-ultrasound-guided-forearm-nerve-blocks-provide-non-drug-pain-relief-acute-injuries]
Watch these quick videos showing US guided nerve blocks of these three nerves!
http://5minsono.com/median-nerve-block/
http://5minsono.com/rnb/
http://5minsono.com/unb/
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