see also: [[Fascia Illiaca block]], [[Bier's block]], [[Neurovascular assessment]] #incomplete see: - [Hayes' - ulnar block](x-devonthink-item://7CE95B56-ADA7-4F86-A02E-BEB23D6246A9), [Radial block](x-devonthink-item://59526B64-4033-4F1C-9EF0-0FED0AF814FE), [Median](x-devonthink-item://41E3CEB4-6231-4B6E-A4F6-E4D2FC531767), [Tibial and sural block](x-devonthink-item://D54656EF-28FA-4EAF-AAA0-D35856F62A8F) - [Robert Hedges - Regional anesthesia of the thorax and extremities](x-devonthink-item://31ACDC98-D2CC-48C5-BE69-E9B37E53FA8C?page=670) # Wrist blocks ## Median nerve ![[Pasted image 20241031233919.png]] ## Radial Nerve ![[Pasted image 20241031233952.png]] ## Ulnar nerve ![[Pasted image 20241031234103.png]] # Ankle blocks # Axillary nerve block this is the ==safest brachial plexus block== because it avoids any risk of phrenic block or pneumothorax, and any unintended arterial puncture can be managed with compression. > - This is the recommended block if you want to provide regional anaesthesia for an upper limb injury. > - More proximal blocks -- eg trying a supracondylar block for radial nerve to treat a colles' -- may be ineffective because patient may require more than just radial nerve block > - it takes a decent amount of time for the local to kick in, and may not provide complete anaesthesia, but enough to do reduction > - a contraindication would be a supracondylar fracture in which you need to monitor for [[Compartment syndrome]] Doses: can mix 10mL of ropivacaine (or lignocaine) in 10mL of saline for total 20mL. inject roughly 10mL to radial and ulna, 7mL around median, and 3mL to musculocutaneous (this is my breakdown; when in doubt just inject roughly 20mL around the axillary artery for the block. ![[Pasted image 20241127084048.png]] ![[Pasted image 20241127123219.png]] ![[Pasted image 20241127122915.png]] ![[Pasted image 20241127162717.png|median nerve path in purple. ulnar and radial are on the other side of the artery]] ![[Pasted image 20241127163135.png]] ![[Pasted image 20241127163348.png]] ![[Pasted image 20241127163451.png]] deep side of triangular axillary sheath sits on conjoint tendon of latissimus dorsi and teres major. anterior side of triangular sheath is adjacent to coracobrachialis. superficial side is adjacent to the deep fascia of the arm. ![[Pasted image 20241127083957.png|I think this is mis-labeled and medial is actually ulnar, ulnar is radial, and radial might be median. and "lateral" is anterior labeled in above images, and "medial" is posterior ]] ![[Pasted image 20241127084018.png]] **indications** anaesthesia to hand. Anaesthesia to forearm if musculocutaneous and medial antebrachial cutaneous nerves are successfully blocked (sometimes missed with this technique due to incorrect identification and anatomical variations). Analgesia to whole arm below the shoulder joint. **Approach** - review on ultrasound first to identify anatomy - place probe high in axilla with arm out at 90deg (can use an arm board) - identify the axillary artery (fairly superficial) - *median nerve* is superficial and anterior (if you are looking from the head and the arm is at 90 deg; it will be towards you / towards the biceps) - *ulnar* and *radial* nerves are on the other side of the artery (ulnar generally more superficial and radial deeper). radial nerve in particular is between the artery and conjoined tendon - the *musculocutaneous* nerve is anterior (same side as median) and deep usually in body of of coracobrachialis - there is **high variability of anatomy** in the axilla (especially musculocutaneous) - release probe pressure and **ensure you see axillary veins** so you do not infiltrate them - make sure your needle injects under the deep fascia of the arm # Sciatic block