Ultrasound Guided Forearm Nerve Blocks: A Short Review

Authors

  •   Subramanyam Subbarayudu Mahankali Senior Consultant Anaesthetist and Academic Co-ordinator, Department of Anaesthesiology, Columbia Asia Referral Hospital, Yeshwantpur, Bangalore – 560055
  •   M. V. Udayshankar Senior Consultant Anaesthetist and Lead Clinician, Department of Anaesthesiology, Columbia Asia Hospital, Whitefield, Bangalore – 560066
  •   Sajana Mukundan Consultant Anaesthetist, Columbia Asia Referral Hospital, Yeshwantpur, Bangalore – 560055

DOI:

https://doi.org/10.4103/kaj/2018/v16i3-4/142049

Keywords:

Median Nerve, Nerve Blocks, Pain Relief, Radial Nerve, Ultrasound, Ulnar Nerve

Abstract

Nerve blocks of the forearm has been used as standalone anaesthetic technique for surgeries of distal forearm and the fingers, it has also been used as a rescue technique for patchy proximal nerve blocks. The use of ultrasound has helped to identify the precise location of the nerve, avoid discomfort of multiple punctures of landmark based technique and avoids the discomfort of paraesthesia associated with the nerve stimulator. A review of the anatomy and the procedure of performing the block are detailed here.

Downloads

Download data is not yet available.

Downloads

Published

2018-12-19

How to Cite

Subbarayudu Mahankali, S., Udayshankar, M. V., & Mukundan, S. (2018). Ultrasound Guided Forearm Nerve Blocks: A Short Review. Karnataka Anaesthesia Journal, 16(3-4), 43–48. https://doi.org/10.4103/kaj/2018/v16i3-4/142049

Issue

Section

Review Article

References

Delaunay L, Chelly JE. Blocks at the wrist provide effective anesthesia for carpal tunnel release, Can. J. Anaesth. 2001; 48(7):656–60. https://doi.org/10.1007/BF03016199. PMid:11495872.

Macaire P, Choquet O, Jochum D, Travers V, Capdevila X. Nerve blocks at the wrist for carpal tunnel release revisited: the use of sensory-nerve and motor-nerve stimulation techniques, 2008, Reg. Anesth. Pain Med. 2005; 30:536–40. https://doi.org/10.1016/j.rapm.2005.06.010, https://doi.org/10.1097/00115550-200511000-00006. PMid:16326338.

Neal JM, Gerancher J, Hebl JR, et al. Upper extremity regional anesthesia: Essentials of our current understanding, Reg. Anesth. Pain. Med. 2009; 34:134–70. https://doi.org/10.1097/AAP.0b013e31819624eb. PMid: 19282714, PMCid: PMC2779737.

Dilger JA, Wells Jr RE. The use of peripheral nerve blocks at the elbow for carpal tunnel release, Journal of Clinical Anesthesia. 2005; 17:621–23. https://doi.org/10.1016/j.jclinane.2005.01.004. PMid: 16427534.

McCartney CJ, Xu D, Constantinescu C, Abbas S, Chan VW. Ultrasound examination of peripheral nerves in the forearm, Regional Anesthesia and Pain Medicine. 2007; 32:434–39. https://doi.org/10.1016/j.rapm.2007.02.011, https://doi.org/10.1097/00115550-200709000-00012. PMid:17961843.

Sohoni A, Nagdev A, Takhar S, Stone M. Forearm ultrasound-guided nerve blocks vs landmark-based wrist blocks for hand anesthesia in healthy volunteers, Am. J. Emerg. Med. 2016; 34:730–34. https://doi.org/10.1016/j.ajem.2016.01.020. PMid: 26920669.

Lewis SR, Price A, Walker KJ, McGrattan K, Smith AF. Ultrasound Guidance for Upper and Lower Limb Blocks. The Cochrane Database of Systematic Reviews, 9, John Wiley & Sons, Ltd.; 2015. p. 1465–858. https:// doi.org/10.1002/14651858.CD006459.pub3. PMCid: PMC6465072.

Delaunay L, Chelly JE. Blocks at the wrist provide effective anesthesia for carpal tunnel release, Canadian Journal of Anaesthesia (Journal Canadien d'Anesthesie). 2001; 48:5660. https://doi.org/10.1007/BF03016199. PMid: 11495872.

Liebmann O, Price D, Mills C, et al. Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department, Annals of Emergency Medicine. 2006; 48:558– 62. https://doi.org/10.1016/j.annemergmed.2006.04.014. PMid: 17052557.

Milligan R, Houmes S, Goldberg LC, Nagdev A, Amini R. Ultrasound-guided forearm nerve blocks in managing hand and finger injuries, Internal and Emergency Medicine. 2017: 1–5. https://doi.org/10.1007/s11739-017-1635-7. PMid: 28188578.

Soberon JR, Bhatt NR, Nossaman BD, Duncan SF, Patterson ME, Sisco-Wise LE. Distal peripheral nerve blockade for patients undergoing hand surgery: A pilot study, Hand (New York, NY). 2015; 10:197–204. https://doi.org/10.1007/s11552-014-9680-4. PMid: 26034430, PMCid: PMC4447669.

Wroe P, O'Shea R, Johnson B, Hoffman R, Nagdev A. Ultrasound-guided forearm nerve blocks for hand blast injuries: Case series and multidisciplinary protocol, Am. J. Emerg. Med. 2016; 34:1895–97. https://doi.org/10.1016/j.ajem.2016.06.111. PMid: 27461885.

Anagnostopoulou S, Saranteas T, Chantzi C, Dimitriou V, Karabinis A, Kostopanagiotou G. Ultrasound identification of the radial nerve and its divisions. Is rescue nerve block at or below the elbow possible? Anaesthesia and Intensive Care. 2008; 36:457–59.

Meco BC, Ozcelik M, Oztuna DG, et al. Can we gain an advantage by combining distal median, radial and ulnar nerve blocks with supraclavicular block? A randomized controlled study, Journal of Anesthesia. 2015; 29:217– 22. https://doi.org/10.1007/s00540-014-1894-7. PMid: 25097089.

Fredrickson MJ, Ting FSH, Chinchanwala S, Boland MR. Concomitant infraclavicular plus distal median, radial, and ulnar nerve blockade accelerates upper extremity anaesthesia and improves block consistency compared with infraclavicular block alone, BJA: British Journal of Anaesthesia. 2011; 107:236–42. https://doi.org/10.1093/ bja/aer101. PMid: 21576095.

Amini R, Kartchner JZ, Nagdev A, Adhikari S. Ultrasoundguided nerve blocks in emergency medicine practice, J. Ultrasound Med. 2016; 35:731–36. https://doi.org/10.7863/ ultra.15.05095. PMid: 26931789.

Frenkel O, Liebmann O, Fischer JW. Ultrasoundguided forearm nerve blocks in kids: A novel method for pain control in the treatment of hand-injured pediatric patients in the emergency department, Pediatr. Emerg. Care. 2015; 31:255–59. https://doi.org/10.1097/ PEC.0000000000000398. PMid: 25803747.

Thompson WL, Malchow RJ. Peripheral nerve blocks and anesthesia of the hand, Military Medicine. 2002; 167:478– 82. https://doi.org/10.1093/milmed/167.6.478. PMid: 12099083.

Henshaw DS, Kittner SL, Jaffe JD. Ultrasound-guided continuous superficial radial nerve block for complex regional pain syndrome, J. Pain Palliat Care Pharmacother. 2016; 30:118–23. https://doi.org/10.3109/15360288.2016.1 173755. PMid: 27159548.

Holman AE, Sharma B, Modest VE. Targeted ultrasoundguided double catheters (Infraclavicular-Brachial Plexus, Median Nerve) facilitate hand rehabilitation with superb analgesia and motor function retention, Scientific Research. 2015; 5(7):142–48. https://doi.org/10.4236/ ojanes.2015.57026.

Ganesh A, Gurnaney HG. Ultrasound guidance for pediatric peripheral nerve blockade, Anesthesiol Clin. 2009; 27:197– 212. https://doi.org/10.1016/j.anclin.2009.06.001. PMid: 19703673.

Watanabe T, Watanabe I, Koizumi M, Petrenko AB, Baba H. Alternative site for median nerve blockade allowing early functional rehabilitation after hand surgery, Canadian Journal of Anesthesia (Journal Canadien d'Anesthésie). 2012; 59:58–62. https://doi.org/10.1007/s12630-011-96134. PMid: 22037985.

Hayton MJ, Stanley JK, Lowe NJ. A review of peripheral nerve blockade as local anaesthesia in the treatment of palmar hyperhidrosis, British Journal of Dermatology. 2003; 149:447–51. https://doi.org/10.1046/j.13652133.2003.05593.x. PMid: 14510973.

Campanati A, Lagalla G, Penna L, Gesuita R, Offidani A. Local neural block at the wrist for treatment of palmar hyperhidrosis with botulinum toxin: Technical improvements, Journal of the American Academy of Dermatology. 2004; 51:345–58. https://doi.org/10.1016/j. jaad.2003.09.006. PMid: 15337974.

McCahon RA, Bedforth NM. Peripheral nerve block at the elbow and wrist, Continuing Education in Anaesthesia Critical Care and Pain. 2007; 7:42–44. https://doi.org/10.1093/bjaceaccp/mkm005.

Sehmbi H, Madjdpour C, Shah UJ, Chin KJ. Ultrasound guided distal peripheral nerve block of the upper limb: A technical review, Journal of Anaesthesiology, Clinical Pharmacology. 2015; 31:296–307. https://doi.org/10.4103/0970-9185.161654. PMid: 26330706, PMCid: PMC4541174.

McCartney CJ, Xu D, Constantinescu C, Abbas S, Chan VW. Ultrasound examination of peripheral nerves in the forearm, Reg. Anesth. Pain Med. 2007; 32:434–39. https://doi.org/10.1016/j.rapm.2007.02.011, https://doi.org/10.1097/00115550-200709000-00012. PMid: 17961843.

Bloc S, Mercadal L, Cadas H. Distal block for wrist bone analgesia: The anterior and posterior interosseous nerves must be blocked, The Journal of Hand Surgery. 2015; 40:2114–15. https://doi.org/10.1016/j.jhsa.2015.05.033. PMid: 26408379.

Unluer EE, Karagoz A, Unluer S, et al. Ultrasound-guided supracondylar radial nerve block for colles fractures in the ED, Am. J. Emerg. Med. 2016; 34:1718–20. https://doi. org/10.1016/j.ajem.2016.06.007

Singh H, Turner M, Stedman A. Ulnar 'dive' identification of the median nerve in the forearm, Anaesthesia. 2014; 69:1405–06. https://doi.org/10.1111/anae.12944. PMid: 25394706.

Thallaj A, El-Dawlatly A, Turkistani A, Zoraigi O, Al-Deen M. Sonoanatomy of the ulnar nerve in the distal forearm, Saudi Journal of Anaesthesia. 2007; 1:53–56.

Ünlüer EE, Karagöz A, Ünlüer S, Oyar O, Özgürbüz U. Ultrasound-guided ulnar nerve block for boxer fractures, The American Journal of Emergency Medicine. 34:1726– 27. https://doi.org/10.1016/j.ajem.2016.06.045. PMid: 27342969.

Kathirgamanathan A, French J, Foxall GL, Hardman JG, Bedforth NM. Delineation of distal ulnar nerve anatomy using ultrasound in volunteers to identify an optimum approach for neural blockade, European Journal of Anaesthesiology. 2009; 26:43–46. https://doi.org/10.1097/ EJA.0b013e328318c5b6. PMid: 19122551.

Hasenkam CS, Hoy GA, Soeding PF. Sensory Distribution of the lateral cutaneous nerve of forearm after ultrasoundguided block: Potential implications for thumb-base surgery, Regional Anesthesia and Pain Medicine. 2017; 42(4):478– 482. https://www.ncbi.nlm.nih.gov/pubmed/28267068.

Snaith R, Dolan J. Ultrasound-guided peripheral upper limb nerve blocks for day-case surgery, Continuing Education in Anaesthesia Critical Care and Pain. 2011; 11:172–76. https://doi.org/10.1093/bjaceaccp/mkr029.

Thallaj A. Ultrasound guidance of uncommon nerve blocks, Saudi Journal of Anaesthesia. 2011; 5:392–94. https://doi.org/10.4103/1658-354X.87269, PMid:22144927. PMCid:PMC3227309.