Mason Wrist And Digital Blocks

Front 1

Contraindications for wirst/digit block

Back 1

Local infection at sites of needle insertion
Preexisting central or peripheral nervous systems disorders
Allergy to local

Front 2

Indications for wrist/digit block

Back 2

Highly effective for procedures on hand and fingers
Carpal tunnel release most common hand surgery in US

Front 3

What are wrist/digit blocks?
Are there any systemic complications?

Back 3

Technique for blocking branches of the ulnar, medial and radial nerves at wrist.
Rare systemic complications

Front 4

Patients can generally tolerate a tourniquet on the arm for ___ minutes.
Wrist tourniquet can be tolerated for about ___ hours.

Back 4

20, 2

Front 5

Radial Nerve, where does it run?

Back 5

Superficial branch runs along medial aspect of brachioradialis muscle.
Then passes between tendon of brachioradialis and radius to pierce fascia on dorsal aspect.
Just above styloid process of radius, it gives off digital branches for dorsal skin of thumb, index finger and lateral half of middle finger.
Several branches pass superficially over the “snuff box”.

Front 6

Median Nerve, where is it?

Back 6

Located between tendons of palmaris longus and flexor carpi radialis.
Palmaris longus tendon is usually more prominent.
Median nerve passes just lateral to it.

Front 7

Ulnar Nerve, where is it?

Back 7

Passes between ulnar artery and tendon of flexor carpi ulnaris.
Tendon of flexor carpi ulnaris is superficial to ulnar nerve.

Front 8

Equipment for wrist/digit block

Back 8

Sterile towels
4 x 4 gauze pads
10 cc syringes with local
1 ½ inch, 25 gauge needle

Front 9

Position for wrist and digit block

Back 9

Patient supine with arm abducted.
Wrist should be dept in slight dorsiflexion.

Front 10

What type of block is the Radial Nerve Block? Explain the process.

Back 10

Field block
Extensive infiltration
5 cc local injected subq just above radial styloid while advancing the needle medially.
Infiltration then extended laterally using additional 5 cc local
Dorsal sensory branch is blocked by inserting the needle 1 cm proximal to redial styloid
Advance needle to Lister’s tubercle and if no paresthesias, inject 5 cc local subq

Front 11

Medial Nerve Block technique

Back 11

Insert needle between tendons of palmaris longus and flexor carpi radialis. Needle is inserted until it pierces deep fascia.
Inject 3-5cc of local.
Insert needle until it contact bone. Withdraw 2-3 mm and inject 2-3cc.
Fan technique--laterally and medially

Front 12

Local for medial nerve block

Back 12

Lidocaine most common
Can use bupivicaine, ropivicaine

Front 13

Ulnar Nerve Block technique

Back 13

Insert needle under tendon of flexor carpi ulnaris muscle close to its distal attachment just above the styloid process of the ulna.
Advanced needle 5-10mm to just past the tendon of the flexor carpi ulnaris.
Inject 3-5cc of local.
Also, inject 2-3cc local just above tendon of flexor carpi ulnaris.
Dorsal sensory branch of ulnar nerve is blocked by inserting needle at level of ulnar styloid
Begin injecting 5cc at flexor carpi ulnaris and extend subcutaneously dorsally toward the distal radioulnar joint.

Front 14

Dorsal sensory branch of ulnar nerve is blocked by inserting needle at level of?

Back 14

ulnar styloid

Front 15

What is a digital block?

Back 15

Blocking nerves of digits to achieve anesthesia of fingers.
Commonly used and effective

Front 16

Equipment for digit blocks.

Back 16

Sterile towels and 4x4 gauze pads
10 cc syringe with local
1 ½ inch, 25 gauge needle

Front 17

Block of Volar and Dorsal Digital Nerves at Base of Finger Technique

Back 17

Insert needle at point on dorsolateral aspect of base of finger
Raise skin wheal
Direct needle anteriorly toward base of phalanx
Needle is advanced adjacent to phalanx.
Watch for protrusion of needle on opposite side.
Inject 2-3cc
Inject additional 1 cc continuously as needle is withdrawn back to the skin.
Repeat on each side of base of finger.

Front 18

Transthecal Digital Block

Back 18

Placed by using the flexor tendon sheath for local injection.
Supinate hand.
Locate flexor tendon.
1 inch needle.
Inject 2-3cc local into flexor tendon sheath at level of distal palmar crease.
Needle should puncture skin at 45 degree angle.

Front 19

Needle should puncture skin at ___ degree angle for the transthecal digital block

Back 19

45

Front 20

Resistance to injection during a transthecal digit block suggests needle tip is against ____ ______

Back 20

flexor tendon.
Careful withdrawal of needle results in free flow of local as potential space between tendon and sheath is entered.
Proximal pressure is applied to volar surface during injection to promote diffusion of local in synovial sheath.

Front 21

Advantages for transthecal digit block

Back 21

Single injection
Higher success rate has been reported.

Front 22

Digit blocks: Onset time typically ___ minutes, depending on concentration and volume of local.

Back 22

5

Front 23

Digital blocks require (large or small) amounts of sedation.

Back 23

little (small)

Front 24

Complication of digital blocks

Back 24

vascular insufficiency and gangrene—rare. Caused by digital artery occlusion along with collateral circulation insufficiency.