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Alternative approaches for regional ulnar nerve blockade: a cadaveric study.
N Lizamore1, E Venter, J M Boon
1Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa. nlizamor@medic.up.ac.za
Clinical Anatomy (New York, N.Y.)
|June 4, 2004
Summary
The ulnar approach for wrist blockade is safer than the volar approach, significantly reducing the risk of ulnar artery injury during hand surgery anesthesia. This study highlights the ulnar approach as a preferred method to avoid potential bleeding complications.
Area of Science:
- Anesthesiology
- Anatomy
- Surgical Techniques
Background:
- Wrist blockade offers a safe alternative to general anesthesia for hand surgery.
- The volar approach to ulnar nerve blockade poses a risk of ulnar artery injury.
- An alternative ulnar approach places the needle posterior to the flexor carpi ulnaris tendon.
Purpose of the Study:
- To compare the incidence of ulnar artery injury between the volar and ulnar approaches for wrist blockade.
- To determine the anatomical relationship between the ulnar nerve and artery at the wrist.
- To identify the safest approach for ulnar nerve blockade to prevent vascular complications.
Main Methods:
- Needles were inserted into 57 cadaver hands using both volar and ulnar approaches.
- Detailed dissection was performed to assess needle placement and document any ulnar artery injury.
- The anatomical position of the ulnar nerve relative to the ulnar artery was recorded.
Main Results:
- The volar approach resulted in ulnar artery damage in 36.8% of cases (21/57).
- The ulnar approach showed no instances of ulnar artery injury (0%).
- The ulnar nerve was consistently located medial to the ulnar artery at the wrist crease.
Conclusions:
- The ulnar approach for wrist blockade is significantly safer regarding ulnar artery injury compared to the volar approach.
- The ulnar approach is recommended, especially when ulnar artery pulsation is unreliable.
- Understanding the precise anatomical relationship is crucial for safe nerve blockade procedures.