Median Nerve Block

  • Superficial to the axillary artery in the axilla
  • Crosses the front of the artery from lateral to medial and can be displaced to either side of the axillary artery with transducer compression



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Median Nerve

Anatomy

  • Formed from medial and lateral cords
  • No branches to arm
  • Passes into the forearm between the heads of pronator trees
  • Gives off the Palmar Cutaneous Branch 
  • Passes below the flexor retinaculum
  • CPT 64450 at Cubital Fossa
  • CPT 20526 for Carpal Tunnel Sheath

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Median nerve

  • CPT  20526 
  • 76942

Indications

Provides anesthesia to

  • The palmar aspect of the thumb, index finger, and middle finger

  • The radial aspect of the ring finger, or radial half of the palm including skin and underlying metacarpals and phalanges.

Contraindications

  • Patient refusal

  • Cellulitis

  • Allergy

Clinical Significance

Carpal Tunnel Syndrome

  • One of the most frequently reported cases of median nerve compression is carpal tunnel syndrome (CTS).
  • When the median nerve is pinched or compressed as it passes through the wrist, CTS develops. 
  • Pain, numbness, and tingling in the median nerve's distribution in the hand are manifestations of the syndrome.

Median Nerve Block

References

and Interesting Articles

  • Pester JM, Bechmann S, Varacallo M. Median Nerve Block Techniques. [Updated 2022 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459141/
  • Jalil H, Polfliet F, Nijs K, Bruckers L, De Wachter G, Callebaut I, Salimans L, Van de Velde M, Stessel B. Efficacy of ultrasound-guided forearm nerve block versus forearm intravenous regional anaesthesia in patients undergoing carpal tunnel release: A randomized controlled trial. PLoS One. 2021 Feb 19;16(2):e0246863. doi: 10.1371/journal.pone.0246863. PMID: 33606754; PMCID: PMC7895351. Link
  • Dufour, E., Jaziri, S., Novillo, M.A. et al. A randomized trial to determine the minimum effective lidocaine volume for median nerve block using hydrodissection. Sci Rep 12, 52 (2022). https://doi.org/10.1038/s41598-021-03660-7



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