Radial Nerve Block Research Articles

Ultrasound-guided proximal radial, ulnar, median and musculocutaneous (RUMM) nerve block in rabbit (Oryctolagus cuniculus) cadavers: medial vs lateral approach

Ultrasound-guided proximal radial, ulnar, median and musculocutaneous (RUMM) nerve block in rabbit (Oryctolagus cuniculus) cadavers: medial vs lateral approach

Anatomical Studies Evaluating Pediatric Regional Anesthesia: A Scoping Review

Background: Pediatric regional anesthesia has been driven by the gradual rise in the adoption of opioid-sparing strategies and the growing concern over the possible adverse effects of general anesthetics on neurodevelopment. Nonetheless, performing regional anesthesia studies in a pediatric population is challenging and accounts for the scarce evidence. This study aimed to review the scientific foundation of studies in cadavers to assess regional anesthesia techniques in children. Methods: We searched the following databases MEDLINE, EMBASE, and Web of Science. We included anatomical cadaver studies assessing peripheral nerve blocks in children. The core data collected from studies were included in tables and comprised block type, block evaluation, results, and conclusion. Results: The search identified 2409 studies, of which, 16 were anatomical studies on the pediatric population. The techniques evaluated were the erector spinae plane block, ilioinguinal/iliohypogastric nerve block, sciatic nerve block, maxillary nerve block, paravertebral block, femoral nerve block, radial nerve block, greater occipital nerve block, infraclavicular brachial plexus block, and infraorbital nerve block. Conclusion: Regional anesthesia techniques are commonly performed in children, but the lack of anatomical studies may result in reservations regarding the dispersion and absorption of local anesthetics. Further anatomical research on pediatric regional anesthesia may guide the practice.

Comparison of supracondylar radial nerve block and procedural sedation analgesia in the reduction of radius fractures

Background and Aim: Distal radius fractures are the most frequent upper extremity fractures in the whole population. The incidence of distal radius fractures is 195.2/100,000, and the rate is increasing. It can occur with low-energy trauma in the elderly associated with osteoporosis. The purpose of this study is to compare the two different treatment groups (1. Sedation analgesia, 2. Supracondylar radial nerve block) in terms of reduction in Visual Analogue Scale (VAS) score, the length of hospital stay, complications, side effects, patient-physician satisfaction, and the ease of application. Materials and Methods: Patients diagnosed with distal radius fracture were enrolled prospectively, to whom the study’s exclusion criteria do not apply. The patients included in the study were randomly separated into two groups. Ketofol was administered to the sedation and analgesia group’s patients at a dose of 0.5 mg/kg (ketamine 0.5 mg/kg, propofol 0.5 mg/kg) intravenously, and supracondylar radial nerve block was performed on the other group’s patients under ultrasound guidance. Results: There were 20 patients (6 male, 14 female) in the sedation and analgesia group and 21 patients (11 male, 10 female) in the supracondylar radial nerve block group. There was no significant difference between the groups regarding patient-physician satisfaction and complications. The length of hospital stay was significantly shorter in the supracondylar radial nerve block group (49.25 ± 4.05) compared with the sedation and analgesia group (125 ± 5.85) (p < 0.01). The mean reduction VAS score in the block group was observed to be lower than the admission VAS score (p < 0.01). Conclusion: Consequently, ultrasound-guided supracondylar radial nerve block would be a valuable alternative to procedural sedation analgesia and could become routine clinical practice in treating distal radius fractures.

Comparative Study of Radial and Median Nerve Blocks with Hematoma Block under Ultrasound Guide in Distal Radius Fracture Reduction: A Randomized Clinical Trial.

Distal radius fractures are one of the most common upper extremity fractures, and their incidence continues to increase due to an aging population and an increase in osteoporosis. Various methods of analgesia for distal radius fractures have been described-including hematoma blocks and nerve blocks. Hematoma blocks are a simple and effective method of providing analgesia; nonetheless, their efficacy may be limited in some cases. On the other hand, nerve blocks provide more targeted analgesia and may be more effective in reducing pain during fracture reduction. This study aimed to compare the analgesic effectiveness of radial and median nerve blocks with hematoma blocks under ultrasound guidance in treating distal radius fractures. Also, this study aimed to compare the analgesia of radial and median nerve blocks with hematoma blocks under ultrasound guidance to reduce distal radius fractures. In this prospective trial, patients with distal radius fractures referring to 2 academic centers were placed into 2 randomized groups, including hematoma block, and radial median block, both of which were ultrasound-guided. The patient's pain levels were measured and recorded based on the visual analog scale before the block, 5, 10, and 15 minutes after the block, at the start of reduction, during reduction, and 5, 10, and 15 minutes after reduction. Patient satisfaction and physician satisfaction rates were assessed, and side effects were also observed for 1 week. Quantitative variables were reported as mean ± standard deviation, and number and frequency percentages were reported for qualitative variables. The Student t test and the chi-square test were used on a case-by-case basis. The significance level was set at P ˂ 0.05. In this study, 120 patients were included. The groups had no significant differences in pain reduction during the procedure. Analgesic medication was needed during the procedure for 17 patients; nerve blocks were applied for 6 patients, and hematoma blocks for 11 patients, which was statistically significant (P = 0.041). Satisfaction rates for patients and physicians performing the procedure were significantly higher in the nerve block group than in the hematoma block group ( P = 0.001; P ˂ 0.001, respectively). The results of this study suggest that ultrasound-guided radial and median nerve blocks can be used as alternative methods of analgesia with other techniques in the reduction of distal radius fractures in emergency departments.

Thermal Imaging to Predict Failed Supraclavicular Brachial Plexus Block: A Prospective Observational Study.

Successful brachial plexus blockade produces sympathetic blockade, resulting in increased skin temperature in the blocked segments. This study aimed to evaluate the accuracy of infrared thermography in predicting failed segmental supraclavicular brachial plexus block. This prospective observational study included adult patients undergoing upper-limb surgery under supraclavicular brachial plexus block. Sensation was evaluated at the dermatomal distribution of the ulnar, median, and radial nerves. Block failure was defined as absence of complete sensory loss 30 min after block completion. Skin temperature was evaluated by infrared thermography at the dermatomal supply of the ulnar, median, and radial nerves at baseline, 5, 10, 15, and 20 min after block completion. The temperature change from the baseline measurement was calculated for each time point. Outcomes were the ability of temperature change at each site to predict failed block of the corresponding nerve using area under receiver-operating characteristic curve (AUC) analysis. Eighty patients were available for the final analysis. The AUC (95% confidence interval [CI]) for the ability of temperature change at 5 min to predict failed ulnar, median, and radial nerve block was 0.79 (0.68-0.87), 0.77 (0.67-0.86), and 0.79 (0.69-0.88). The AUC (95% CI) increased progressively and reached its maximum values at 15 min (ulnar nerve 0.98 [0.92-1.00], median nerve 0.97 [0.90-0.99], radial nerve 0.96 [0.89-0.99]) with negative predictive value of 100%. Infrared thermography of different skin segments provides an accurate tool for predicting failed supraclavicular brachial plexus block. Increased skin temperature at each segment can exclude block failure in the corresponding nerve with 100% accuracy.

Fentanyl sparing effect of ultrasound-guided proximal radial, ulnar, median, and musculocutaneous nerve (RUMM) block for radial and ulnar fracture repair in dogs: a retrospective case-control study.

This study retrospectively evaluated the fentanyl-sparing effect of ultrasound-guided proximal radial, ulnar, median, and musculocutaneous nerve (RUMM) block for radial and ulnar fracture repair in dogs. Fentanyl was prepared for intraoperative analgesia in dogs, although proximal RUMM block was performed using 0.5% or 0.25% bupivacaine before surgery in the block group. Dogs without a nerve block were assigned to the control group. The fentanyl dose in the block group [0.8 (0-1.9) μg/kg/hr] [median (interquartile range)] was significantly lower than in the control group [8.4 (7.2-10) μg/kg/hr]. Surgery was performed without fentanyl in >50% of the dogs (5/7), using 0.5% bupivacaine. Ultrasound-guided proximal RUMM block can be useful as an intraoperative analgesic for radial and ulnar fracture repair in dogs.

Ultrasound-guided superficial radial nerve block: A novel analgesia technique for cephalic vein cannulation in hand.

Ultrasound-guided superficial radial nerve block: A novel analgesia technique for cephalic vein cannulation in hand.

Effectiveness of Peripheral Median, Radial, and Ulnar Nerve Block at Wrist along with Intra-Articular Steroid Injection in Shoulder Joint in Management of Complex Regional Pain Syndrome of Upper Limb: 1-Week Follow-Up Study.

Complex regional pain syndrome (CRPS) of upper limbs is one of the under-recognized painful disabling condition seen in many neurological conditions. To see the effectiveness of peripheral nerve blocks (PNB) along with intra-articular injection in shoulder joint in the improvement of pain, swelling and range of motion (ROM) of the upper limb in CRPS. It was a single-center, prospective study in male and female patients between 18 and 70 years with CRPS of the upper limb due to any etiology, within one year of illness. Single-dose of the intra-articular shoulder joint injection and peripheral nerve blocks at the wrist with steroid, 2% lignocaine, and sterile water was given. The primary outcome measure was a reduction in pain in the upper limb, assessed with a visual analog scale (VAS). Secondary outcome measures were an improvement in passive ROM of joints and a decrease in swelling of the hand. The significance of the P value was adjudged against an alpha of 0.05. Thirty-three patients (25 men), with a mean (SD) age of 55.2 (9.4) years, and mean (SD) duration of illness of 101.9 (76.8) days were included. After 1 week, there was a significant improvement (P < 0.05) in the ROM of joints. The decrease in pain scores on VAS [mean difference -5.1 (CI -5.7, -4.5)] and reduction in hand swelling [mean difference -0.9 (CI -1.1, -0.7)] was also significant. Peripheral median, radial, and ulnar nerve block at wrist along with intra-articular steroid injection in the shoulder joint is an effective method of management of CRPS of the upper limb.

Standardizing the technique of radial, ulnar, musculocutaneous and median (RUMM) nerve block in dogs

Standardizing the technique of radial, ulnar, musculocutaneous and median (RUMM) nerve block in dogs

Does radial or median nerve blocks affect the area and blood flow of radial artery?

Background and aimsRadial artery is a common site of cannulation in acute care setting. There are conflicting reports as to which nerve, radial or median or both supplies the radial artery. We did this prospective study in patients undergoing minor procedures under peripheral nerve blocks to ascertain which nerve block, radial or median increases the cross sectional area and blood flow in the radial artery. MethodsNinety ASA I/II patients undergoing upper limb minor surgeries under various blocks (radial or median or radial + median nerve) were enrolled in this study. Patients in group R were those who received Ultrasound-guided (USG) radial nerve block, group M median nerve block while group MR received both the nerve blocks. The primary objective was to assess the increase in cross sectional area (CSA) of radial artery in the groups after the block. Secondary objectives included assessment of time average maximum velocity (TAMAX) and blood volume (BV) after the block. ResultsThe CSA, TAMAX and BV of radial artery increased in all the three groups. Within each group the difference between the preblock and postblock parameters were highly significant. However, the differences are greater in groups M and M + R than in group R; (P < 0.001). ConclusionUltrasound-guided median nerve block causes arterial vasodilation, and an increase in radial artery blood flow velocity. There was no added benefit of radial block along with median block in increasing the blood flow further.

Ultrasound-Guided Alcohol Neurolysis For Treatment of Refractory Radial Neuralgia

Background: The radial nerve is especially vulnerable to injury due to its location near the humerus. When acute pain becomes chronic and surgical repair is no longer an option, it is necessary to have non-opioid, nonpharmacological methods of pain relief. Case Report: A 63-year-old man presented with severe radial nerve neuralgia secondary to traumatic left upper extremity injury 40 years ago. After several unsuccessful surgical interventions and failing medication management, he was sent to pain management as a last resort prior to elective amputation of the left upper limb. After initial evaluation, the patient underwent a diagnostic ultrasound-guided radial nerve block at the midhumeral level with complete but short-lasting relief of his pain. Shortly after, we performed ultrasoundguided alcohol neurolysis of the radial nerve at the same level. This treatment resulted in 100% pain relief for 10 months with gradual resumption of pain to previous levels at 12 months post neurolysis. Conclusion: Alcohol neurolysis is an effective and viable option for the treatment of neuralgia resistant to other therapeutic modalities. To our knowledge, this is the first case report that describes the use of ultrasound to perform chemical neurolysis of the radial nerve. Key words: Alcohol neurolysis, chronic pain, nerve ablation, neuralgia, neurolysis, opioids, radial nerve, traumatic injury, ultrasound

Ultrasound-guided supracondylar radial nerve block to manage distal radius fractures in the emergency department

Background: Distal radius fractures, the most prevalent of all fracture types, are often associated with severe pain and discomfort and treated with closed reduction and splinting. This study aimed to compare ultrasound-guided supracondylar radial nerve block with procedural sedation for the treatment of distal radius fractures in the emergency department. Methods: Patients with isolated distal radius fractures and limited displacement who met the inclusion criteria were randomly divided into two groups, an ultrasound-guided nerve block group and a procedural sedation group, which were compared in terms of managing patients with distal radius fractures. The number of patients in each group was 27. Results: The duration of the procedure was significantly shorter in the nerve block group than in the ketamine group (p &lt; 0.001). Physician and patient satisfaction were determined according to the unipolar Likert scale and unlike for patients (p = 0.001), no significant difference was noted between the two groups for the physicians (p = 0.619). Unlike nerve block, emergence reactions (p = 0.038) and vomiting (p = 0.009) occurred in the ketamine intervention. Conclusion: Ultrasound-guided supracondylar radial nerve block can be prescribed as an alternative method in minimal or non-displaced distal radius fractures instead of IV sedation due to fewer side effects and a shorter procedural duration.

A Cadaveric Study of Radial Nerve Course and its Clinical Implications on Radial Nerve Block at Elbow

Introduction: Upper limb nerve blocks are done commonly by brachial plexus (C5-T1) blocks via supraclavicular, infraclavicular approaches. Sometimes a single peripheral nerve needs additional block with local anaesthetic to achieve adequate block. Peripheral nerve blocks are useful for minor surgical procedures in a single nerve distribution. Aim: To study the course and clinical significance of the radial nerve in 50 cadaveric upper limbs. Materials and Methods: A cross-sectional study was conducted on 50 intact dissected upper limbs. The upper limbs were obtained from the Department of Anatomy, Sri Ramachandra Medical College from August 2020 to December 2020. Radial nerve was exposed by routine dissection in all the upper limbs and its entire course was studied and observed for any variation. The distance from the biceps tendon to the radial nerve at the elbow, distance of the radial nerve in the Lateral Intermuscular Septum (LIS) from the epicondyles at the elbow were measured. The results obtained were statistically analysed using Statistical Package for the Social Sciences (SPSS) version 16.0. Results: In present study, the mean distance of the radial nerve in the LIS to the medial epicondyle was 12.4±0.31 cm and to the lateral epicondyle was 12.1±0.28 cm. The mean distance from the biceps tendon to the radial nerve at the elbow was 1.75±0.22 cm. Conclusion: From the present study, it can be inferred that effective peripheral radial nerve block can be achieved by blocking the nerve 1.75 cm lateral to the biceps tendon at the elbow 3 cm above the elbow crease. This can be made comfortable to the patient and more precise by ultrasound localisation of the radial nerve.

Development of a lateral ultrasound-guided approach for the radial, ulnar, median and musculocutaneous (RUMM) nerve block in a calf undergoing surgical fixation of the antebrachium

A 26-day-old Pustertaler Sprinzer calf was referred to the ruminant clinic of the Veterinary University of Vienna for internal fixation of a suspected traumatic radius–ulnar fracture of the left forelimb....

Development of a lateral ultrasound-guided approach for the proximal radial, ulnar, median and musculocutaneous (RUMM) nerve block in cats

ObjectiveTo describe a lateral ultrasound (US)-guided approach to the radial, ulnar, median and musculocutaneous (RUMM) nerves through a single proximal in-plane insertion in cats and to determine whether one or two injection points are required to successfully stain all the target nerves. Study designProspective study. AnimalsA total of eight client-owned healthy cats and 12 cat cadavers. MethodsIn live cats, the US anatomy of the brachium, the landmarks and the site for needle accesses were determined. Then, 12 thawed feline cadavers were used to assess the spread of dye solution and nerve staining following the US-guided proximal-lateral-humeral RUMM injection using one and two injection points. Each cadaver was injected with 0.15 mL kg–1 of a 0.25% new methylene blue solution in either a single injection aimed for the radial nerve of one limb (G1) or via two sites delivering 0.1 mL kg–1 and 0.05 mL kg–1 aimed for the radial and musculocutaneous nerves of the opposite limb, respectively (G2). Upon dissection, staining of the target nerves around their circumference for length of >1 cm was considered successful. ResultsSonoanatomy was consistent with anatomy upon dissection and target nerves were identified in all cadavers. Staining was 100% successful for the radial, median and ulnar nerves in both groups, and 41.7% and 100% for the musculocutaneous nerve in G1 and G2, respectively. Conclusions and clinical relevanceThis novel lateral US-guided approach for the proximal RUMM nerve block allowed a good identification of the nerves and related structures, and it provided a consistent muscular structure through which the needle could be easily guided. An injection performed in two aliquots (within the caudal and cranial compartments of the neurovascular sheath) appeared to be necessary to successfully stain all the target nerves.

In-plane and out-of-plane needle insertion comparison for a novel lateral block of the radial, ulnar, median and musculocutaneous nerves in cats

ObjectiveTo compare two needle insertion techniques in a novel lateral approach to the radial, ulnar, median and musculocutaneous (RUMM) nerve block in cat cadavers. Study designProspective, cadaveric experimental study. AnimalsA group of 18 feline cadavers. MethodsCadavers were divided into two groups. Both thoracic limbs of each cat were ‘blocked’ using the ‘in-plane’ (IP) or ‘out-of-plane’ (OP) ultrasound (US)-guided method. A single operator with limited experience performed all the techniques. Cadavers were placed in lateral recumbency and the uppermost limb was injected before turning to ‘block’ the contralateral limb in the same manner. The IP method consisted of tracking the triceps brachii muscle until the radial (R) nerve could be identified in the same field of view as the ulnar, median and musculocutaneous (UMM) nerve bundle. A needle was guided by US towards the R nerve and subsequently, methylene blue (0.4 mL) was instilled adjacent to it. The needle was retracted and redirected to the UMM nerve bundle, and another 0.4 mL dye was instilled. For the OP technique, the limb was pronated at a 45° angle. The nerves were then identified with the R nerve directly above UMM nerves. A needle was directed OP deep towards UMM nerves and dye (0.4 mL) was instilled. The needle was retracted superficially and 0.4 mL dye instilled next to the R nerve. After dissection, the nerves were assessed and ≥6 mm of staining was considered a successful technique. ResultsA total of 18 RUMM ‘blocks’ were performed IP and 18 were performed OP. The IP technique was more successful than the OP technique (R nerve p = 0.0339; UMM nerves p = 0.0352). Conclusions and clinical relevanceThe lateral approach to the RUMM was achievable in cat cadavers using both needle insertion techniques. The IP technique was significantly more successful than the OP technique.

Proximal RUMM block in dogs: preliminary results of cadaveric and clinical studies

ObjectiveTo design and assess the perioperative analgesic efficacy of an ultrasound (US)-guided radial (R), ulnar (U), median (M) and musculocutaneous (Mc) nerve blocks, performed together in the axillary space by a single, in-plane approach. Study designAnatomical research and prospective clinical study. AnimalsA group of three dog cadavers and 15 client-owned dogs undergoing orthopaedic thoracic limb surgery. MethodsPhase 1: Anatomical dissection and US study of the axillary space were performed to design the US-guided proximal RUMM block. The technique was considered successful if a total volume of 0.15 mL kg–1 new methylene blue solution completely stained the four nerves in two cadavers for ≥2 cm. Phase 2: In 15 client-owned dogs undergoing orthopaedic thoracic limb surgery, the RUMM block designed in phase 1 was performed to provide analgesia using a total volume of 0.15 mL kg–1 of ropivacaine 0.5%. The block was considered effective if the intraoperative fentanyl requirement was <1.2 mcg kg–1 hour–1 and until the postoperative pain score was [short-form Glasgow Composite Measure Pain Scale (SF-GCMPS)] ≤5/20. ResultsPhase1: Detection of the four nerves was always feasible in a single US-window. The axillary artery and Mc nerve were used as landmarks. In-plane needling approach was feasible in both cadavers. All the nerves were completely stained for >2 cm. No intrathoracic dye spread was found. Phase 2: In 14/15 anaesthetized dogs, mean intraoperative fentanyl requirement was 0.25 ± 0.05 mcg kg–1 hour–1. Postoperatively, all dogs had SF-GCMPS ≤5/20 up to 8 hours. Conclusions and clinical relevanceThe US-guided proximal RUMM block performed at the axillary level with a single, in-plane needling approach using 0.15 mL kg–1 of ropivacaine 0.5% minimized fentanyl requirement during thoracic limb surgery, contributing to postoperative analgesia up to 8 hours after execution of the peripheral nerve block.

Ultrasound-guided supracondylar radial nerve block in pain management of distal radius fractures

Radius fracture causes severe pain and requires extensive pain management. We aimed to present the efficacy of ultrasound (US)-guided supracondylar radial nerve block (SCRNB) in pain relief of two distal radius fracture cases. Two patients with distal radius fracture presented to emergency department. Both patients received US-guided SCRNB to provide analgesia during and after the closed reduction procedure. Reduction of displaced distal radial fractures is extremely painful and requires adequate analgesia. US-guided SCRNB is easy to administer, and comfortable with low complication risk. In previous studies, the preferred local anesthetic was lidocaine. Using bupivacaine in addition to lidocaine can provide long term analgesia. US-guided SCRNB is a safe and simple technique to perform with a minimal risk of complication and may replace commonly used sedo-analgesia in distal radius fracture at emergency department.

Nerve Stimulator-guided radial nerve block at elbow: New approach for the treatment of tennis elbow

Lateral epicondylitis, or “tennis elbow,” is a symptomatic chronic degeneration of the wrist extensor tendons that involves their attachment to the lateral epicondyle of the humerus. Analgesic, percutaneous, and arthroscopic surgery techniques have been used with no significant difference in the outcome. We report four cases of patients suffering from lateral epicondylitis who received nerve stimulator-guided radial nerve block for pain management. The patients had substantial and extended reduction of pain.

Effectiveness of Superficial Radial Nerve Block on Pain, Function and Quality of Life in Patients With Hand Osteoarthritis: A Prospective, Randomized and Controlled Single-Blind Study.

This study aims to investigate the effects of ultrasound-guided superficial branch of the radial nerve block on pain, function and quality of life in patients with hand osteoarthritis. In this prospective, randomized and controlled single-blind study, 50 female patients (mean age 59.0±5.1 years; range, 46 to 64 years) diagnosed with hand osteoarthritis were randomized into two groups. Group 1 (n=25) was administered an ultrasound-guided superficial branch of the radial nerve injection (with a combination of 2 mL 0.25% bupivacaine and 1 mL methylprednisolone acetate) + exercise, while group 2 (n=25) only exercised. Patients were assessed with a visual analog scale for pain, hand grip strength, finger grip strength, Quick Disability of the Arm, Shoulder and Hand questionnaire, Duruöz Hand Index and Short-form 12. Data were obtained before treatment (W0), in the second week after treatment (W2) and in the fourth week after treatment (W4). In group 1, a statistically significant improvement was obtained in all parameters at both W2 and W4 compared to the values recorded at W0 (p<0.05). In group 2, a statistically significant improvement was observed only in the parameters of hand grip strength and finger grip strength at W2 and W4 (p<0.05). A comparison of the scores of the two groups showed statistically significant superior improvement in group 1 in all parameters at both W2 and W4 (p<0.05). The findings of our study showed that an ultrasound-guided superficial branch of the radial nerve block combined with exercise is a significantly superior treatment to exercise-only regarding the improvements in the parameters of pain, function and quality of life in hand osteoarthritis patients.