Special Operations Forces Medical Handbook

5-166

Wr ist slightly extended

in supine position

Palmaris longus

tendon

Median nerve

Median Nerve Block at the Wr ist

resistance. Then slowly advanced the needle an additional 2-3 millimeters.

4. If paresthesia is elicited, then slowly inject 5 mls of local anesthetic solution. In the
   event of resistance to injection or pain (could be due to intraneural injection) stop and
   withdraw the needle 2 millimeters before continuing


5. Withdraw the needle to the subcutaneous level while injecting an additional 2-3 mls of
   local anesthetic solution.

What Not To Do: See IIIb & IIIc
Contraindications: Do not use a median nerve block in the presence of carpal tunnel syndrome.

c. Radial Nerve Block at the Wrist (Figure 5-36)

What To Do:

1. Assemble equipment.


2. Prep area


3. Extend the thumb against resistance, revealing the “anatomical snuff box,” which is the area just
   above the styloid process of the radius.


4. Insert a 25 or 27 gauge needle close to the tendon of extensor pollicis longus over the styloid process
   of the radius. Direct it subcutaneously across the dorsum of the wrist towards the ulnar border. Inject
   5-7 mls of local anesthetic solution as the needle is advanced.


5. Withdraw the needle to the insertion point and redirect it across the tendon of the flexor
   pollicis brevis and inject and additional 2-3 mls of solution subcutaneously

Figure 5-35