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Mastering Wrist Nerve Blocks: Landmark & Ultrasound-Guided Approaches

Wrist nerve blocks offer precise anesthesia for hand and wrist procedures, providing effective pain control while eliminating the need for general anesthesia. In this blog, we highlight the expert techniques demonstrated by Dr. Jeff Gadsden and the Duke Regional Anesthesia team in the video "Wrist Blocks (Landmark AND Ultrasound Guided Approaches!)" and explores both landmark-based and ultrasound-guided approaches, offering valuable insights for optimizing precision and patient outcomes.

Let’s explore the key takeaways from their technique-driven approach.

Why Wrist Blocks Matter

By targeting the median, ulnar, and radial nerves, wrist blocks allow selective anesthesia while preserving essential motor function. This technique is particularly effective for:

  • Carpal tunnel release

  • Trigger finger surgery

  • Tendon repairs

  • Hand fracture fixation

Wrist blocks eliminate the need for general anesthesia, leading to faster recovery, fewer systemic side effects, and improved postoperative pain control.

Step-by-Step Guide to Wrist Nerve Blocks
1. Patient Preparation

  • Position the patient supine with the arm extended on a flat surface.

  • Ensure the wrist is slightly flexed to improve access to nerve structures.

  • Clean the area with antiseptic solution and apply sterile drapes.

2. Identifying Nerve Landmarks

  • Median Nerve: Located between the palmaris longus and flexor carpi radialis tendons.

  • Ulnar Nerve: Found near the flexor carpi ulnaris tendon.

  • Radial Nerve: Lies near the styloid process of the radius.

3. Landmark-Guided Technique

  • Palpate the anatomical landmarks to locate the nerves.

  • Insert a fine-gauge needle at each nerve site.

  • Aspirate to ensure no intravascular placement before injecting.

  • Administer small volumes of local anesthetic around each nerve.



4. Ultrasound-Guided Technique

  • Place a high-frequency linear probe transversely at the wrist crease.

  • Identify the median, ulnar, and radial nerves using ultrasound imaging.

  • Advance the needle under real-time ultrasound guidance toward each nerve.

  • Confirm anesthetic spread around the nerve before completing the injection.

5. Post-Procedure Considerations

  • Monitor for signs of nerve irritation or vascular injection.

  • Ensure adequate anesthesia before proceeding with surgery.

  • Document the procedure, including needle placement and anesthetic volume.

Refinements in Wrist Block Technique

  • Optimized Needle Placement: The video emphasizes a steeper needle angle for better anesthetic spread, reducing the risk of intraneural injection.

  • Adjusting Volume for Precision: Instead of a standard dose, the instructors highlight tailoring anesthetic volume based on patient anatomy to avoid excessive spread.

  • Dynamic Ultrasound Scanning: A pre-injection scan helps identify subtle anatomical variations, ensuring more accurate nerve targeting.

Practical Tips

  • Avoiding Median Nerve Compression: The video warns against injecting too close to the carpal tunnel, which can cause temporary nerve irritation.

  • Ulnar Nerve Safety Check: Since the ulnar artery runs close to the nerve, multiple aspirations before injection help prevent accidental intravascular placement.

  • Patient Positioning for Comfort: A slight wrist flexion improves access while minimizing patient discomfort during the procedure.

Final Thoughts

Wrist nerve blocks remain a cornerstone of regional anesthesia, offering safe, effective, and efficient alternatives to general anesthesia. Whether using landmark-based techniques or ultrasound guidance, mastering this approach enhances precision and patient outcomes.

For an in-depth walkthrough, watch the full video below.

Valkyrie's Commitment to Teaching and Learning Through Simulation

At Valkyrie, we believe in advancing medical education through simulation. Our dedication to refining regional anesthesia techniques ensures that clinicians gain hands-on experience in nerve blocks with the highest level of precision. Learn more about our commitment to simulation training here.



Wrist Block Simulator

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