Special Operations Forces Medical Handbook

5-164

syringe, 25 or 27-gauge needle, local anesthetic.

b. For the rest of this section, the following rationale will be referred to as Standard Contraindications in
the What Not To Do paragraph, unless otherwise indicated: Local anesthetics should be avoided in
patients reporting allergies to them.

c. For the rest of this section, the following rationale will be referred to as Standard Complications in the
What Not To Do paragraph, unless otherwise indicated: Tissue ischemia and necrosis. Large volumes of
local anesthetics can lead to mechanical compression and ischemia.

IV. Nerve Blockade of the Hand and Wrist

When: This blockade is particularly valuable when you need to maintain some motor function during surgery.
Blockade will produce sensory loss in their hand, and motor loss in the intrinsic muscles of the hand, but not
loss of the extension or flexion of the hand or wrist. If complete sensory and motor blockade is required,
brachial plexus blockade is a more acceptable alternative.

What You Need: Standard Equipment: In order to achieve analgesia of the entire hand and wrist the
ulnar, both the median and radial nerves must be blocked. NOTE: Additional techniques are discussed
on the CD-ROM.

a. Ulnar Nerve Block at the Wrist (Figures 5-33, 5-34)

What To Do:

1. Assemble equipment.


2. Prep area.


3. Block the palmar branch by inserting a 25 or 27 gauge needle at 90° to the skin, lateral to the flexor

Ulnar Nerve Block, Ventral Approach

Ulnar artery

Supine arm

Figure 5-33