USG Guided Forearm Nerve Block

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Vol 2 | Issue 1 | January-June 2021 | Page 72-77 | Madhuri Dadke, Sandeep Diwan

Authors: Madhuri Dadke [1], Sandeep Diwan [1]

[1] Department of Anaesthesia, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence
Dr. Sandeep Diwan,
Consultant Anaesthesiologist, Sancheti Hospital, Pune, Maharashtra, India.
E-mail: sdiwan14@gmail.com

Introduction

Forearm blocks (FAB) are implemented to provide anaesthesia for hand surgeries, as a rescue block for failed or patchy proximal brachial plexus block and to provide postoperative analgesia after a regional or a general anaesthetic [1]. The advantage of these distal blocks is preservation of proximal motor function and avoidance of central structures such as the pleura, subclavian or axillary artery and the phrenic nerve. The proximal muscle function is preserved with these blocks, requiring minimal doses of local anaesthetic. These blocks can be implemented in outpatients [2] and with patients on anticoagulants [3]. Distal nerve blocks do not prevent tourniquet pain since the lateral antebrachial cutaneous nerve of forearm (musculocutaneous nerve), the medial cutaneous nerve of the arm, the posterior cutaneous nerve of the arm, and the intercostobrachial nerve that provide cutaneous innervation of the upper arm are not blocked [4]. The above mentioned nerves are blocked in the arm. Blockade of multiple nerves are needed and so involves multiple injections that may cause more patient discomfort.

References

1) Sayeh Hazmenzedeh, David Bravos.Peripheral Nerve Blocks of the Distal Upper Extremity.ASRA 2019
2) Liebmann O, Price D, Mills C, Gardner R, Wang R, Wilson S, et al.Feasibility of forearm ultrasonography guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department.Ann Emerg Med 2006,48:558-62.
3) Jose Soberon,Neil Bhatt,Bobby Nossamon,Scott Duncan et al.Distal peripheral nerve blockade for patients undergoing hand surgery: a pilot study.Hand(New York)2015 Jun; 10(2): 197–204.
4) Herman Sehmbi,Caveh Madjdpour,Ushma Jitendra Shah,Ki Jinn Shin.Ultrasound guided distal peripheral nerve block of the upper limb: A technical review.JOACP 2015.Volume 31,issue3,296-307.
5) Jordan M.Brown, Corrie M. Yablon , Yoav Morag, Catherine J. Brandon, Jon A. Jacobson.Ultrasound of the Peripheral Nerves of the Upper Extremity: A Landmark Approach. RadioGraphics 2016; 36:452–463.
6) Chad Robertson,John Saratsiotis.A Review of Compressive Ulnar Neuropathy at the Elbow. Journal of manipulative and physiological therapeutics ,June 2005;28(5):345.
7) Henrich Kele.Ultrasonography of the peripheral nervous system. Perspectives in Medicine 2012.Volume 1, Issues 1–12, September 2012, Pages 417-421
8) Admir Hadzic.Ultrasound-Guided Forearm Blocks. Hadzic’s Nerve Blocks and Anatomy for Ultrasound Guided Regional Anesthesia, 2e.
9) Wachara Wongkerdsook,Sithiporn Agthong,Chavarin Amarase,Pattarapol Yotnuengnit,Thanasil Huanmanop,Vilai Chentanez. Anatomy of the lateral antebrachial cutaneous nerve in relation to the lateral epicondyle and cephalic vein. Clinical Anat. Jan 2011;24(1):56-61.
10) Thomas K, Sajjad H, Bordoni B. Anatomy, Shoulder and Upper Limb, Medial Brachial Cutaneous Nerve. Treasure Island : Feb 14,2021.
11) Starr,Dennis Lee,Peter Stern. Anatomy of the Posterior Antebrachial Cutaneous Nerve, Revisited.Scientific Article Volume 45,Issue4,April 2020.
12) M Lurf et al.Ultrasound guided ulnar nerve catheter placement in the forearm for postoperative pain relief and physiotherapy. Acta Anaesthesiology Scandinavia. Feb 2009;53(2):261-3
13) Sanjeev Bhoi, Amit Chandra, Sagar Galwankar. Ultrasound-guided nerve blocks in the emergency department Journal of emergencies trauma and shock.Jan-Mar 2010. 3(1): 82–88.
14) RA McCahon,NM Bedforth.Peripheral nerve blocks at the elbow and wrist.Critical Care & Pain journal,Volume 7, Issue 2, April 2007, Pages 42–44.
15) Brian M Ilfeld.Continuous .Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities.Anesth Analg ,2017 Jan;124(1):308-335.

How to Cite this Article: Dadke M, Diwan S | USG Guided Forearm Nerve Block | International Journal of Regional Anaesthesia | January- June 2021; 2(1): 72-77.

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