Indications
- Forearm laceration or injury
Contraindications
- Infection overlying injection site
- Allergy to local anesthetic
Equipment
- 5cc of local anesthetic of choice
- 25-27G needle
- Saline Flush
- Cleansing solution
- Ultrasound with high-frequency linear transducer
- Ultrasound transducer sterile cover
Preparation
Position
Position the patient supine with arm abducted and supinated.
Ultrasound
Landmarks
- Place the transducer in transverse plane on the medial aspect of the upper extremity approximately mid-way along the arm
- Identify the biceps and triceps muscles as well as the neurovascular bundle containing: brachial artery, basilic vein and median nerve
- The medial antebrachial cutaneous nerve (MACN) is superficial to the triceps muscle
Technique
- In-plane needle visualization
- Introduce needle from lateral aspect of proximal upper extremity (superior to the transducer)
- Maintain needle superficial to the neurovascular bundle, aspirate to avoid inadvertant intravascular injection
- Deposit local anesthetic deep to the MACN