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LETTERS TO EDITOR
Year : 2023 | Volume
: 17
| Issue : 1 | Page : 120-121
Ultrasound-guided superficial radial nerve block: A novel analgesia technique for cephalic vein cannulation in hand
Chitta R Mohanty1, Rakesh V Radhakrishnan2, Neha Singh3, Tarangini Das4, Seshendra S Akelia1
1 Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
3 Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
4 Department of Anesthesiology and Critical Care, FM Medical College, Balasore, Odisha, India
Correspondence Address:
Chitta R Mohanty
Department of Trauma and Emergency, All India Institute of Medical Science, Bhubaneswar - 751 019, Odisha
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/sja.sja_344_22
| Date of Submission | 28-Apr-2022 |
| Date of Decision | 29-Apr-2022 |
| Date of Acceptance | 29-Apr-2022 |
| Date of Web Publication | 02-Jan-2023 |
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How to cite this article:
Mohanty CR, Radhakrishnan RV, Singh N, Das T, Akelia SS. Ultrasound-guided superficial radial nerve block: A novel analgesia technique for cephalic vein cannulation in hand. Saudi J Anaesth 2023;17:120-1 |
How to cite this URL:
Mohanty CR, Radhakrishnan RV, Singh N, Das T, Akelia SS. Ultrasound-guided superficial radial nerve block: A novel analgesia technique for cephalic vein cannulation in hand. Saudi J Anaesth [serial online] 2023 [cited 2023 Mar 31];17:120-1. Available from: https://www.saudija.org/text.asp?2023/17/1/120/364848 |
To the Editor,
Peripheral intravenous cannulation (PIVC) is a routine procedure before any anesthetic technique. Large-bore PIVC (16 gauge or 18 gauge) is frequently required for patients with polytrauma and major surgeries as they necessitate rapid and large volume fluid resuscitation. The cannulation of large-bore PIVC is associated more pain and discomfort.[1],[2] The cephalic vein on the dorsum of the hand is preferred for cannulation of large-bore PIVC. Local infiltration of lignocaine is commonly used for pain control during large bore PIVC but it has some disadvantages.[2] Here, we describe the novel technique of ultrasound-guided superficial radial nerve (SRN) block for procedural analgesia for cephalic vein cannulation.
The radial nerve divides into the SRN and posterior interosseous nerves anterior to the elbow at the level of the tip of the lateral epicondyle. The SRN then descends anterolaterally in the proximal two-thirds of the forearm, initially lying on the supinator, lateral to the radial artery, and deep to brachioradialis.[3] In the middle third of the forearm, the SRN lies deep to the brachioradialis and lateral to the radial artery in one neurovascular sheath [Figure 1]d. The nerve leaves the radial artery at 7 cm proximal to the wrist, then curves around the lateral side of the radius, and divides into branches that supply sensory innervation to the dorsal surface of the hand [Figure 1]a. A standard 26-gauge 19 mm length needle can easily reach the site of the SRN in the middle third of the forearm to deposit the local anesthesia using the in-plane technique with a linear transducer probe [Figure 1]c. Only 1-1.5 ml of 1-2% lignocaine is enough to block SRN and provide excellent analgesia. The area of cannulation can be checked for analgesia by loss of sensation to cold or gentle pinprick before proceeding for cephalic PIVC [Figure 1]b. The SRN block at the above point is not associated with any motor blockage. The nerve is easy to identify and block at this level under ultrasound guidance, and the learning curve is short. | Figure 1: (a) Image of dorsolateral surface of hand showing sensory innervation of superficial radial nerve; (b) The dorsolateral surface of hand showing cephalic vein (yellow arrow) and site of cannulation (yellow arrow); (c) The position of the linear ultrasound probe in middle third of the forearm; (d)Sonoanatomy at middle third of forearm showing superficial radial nerve (blue arrow) and radial artery (red arrow)
Click here to view |
Lignocaine local infiltration (LLI) 1-2% has frequently been recommended for pain control during PIVC.[2] The local infiltration around the cannulation site has a vasoconstrictive effect that may cause difficulty in identifying the vein, rendering cannulation difficult and may reduce the success rate.[2],[4] The vapocoolant sprays are the alternative pain control measures but are generally expensive and carry the drawbacks of having some local vasoconstrictive effects due to surface cooling leading to difficulty in identifying veins.[1],[2] The SRN blocks can provide excellent analgesia for PIVC, particularly while inserting large-bore cannulas. The technique is superior to LLI techniques as the site of needle insertion is different from cannulation and additional vasodilation from the nerve block which can improve the venous access and success rate.
To conclude, SRN block can provide excellent analgesia for large bore venous cannulation in the dorsum of the hand. The SRN block is a simple technique to learn and practice. Effective procedural pain management can improve the success rate of venous cannulation, enhance patient cooperation, and comfort.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Rao PB, Mohanty CR, Singh N, Mund M, Patel A, Sahoo AK. Effectiveness of different techniques of ethyl chloride spray for Venepuncture-induced pain: A randomised controlled trial. Anesth Essays Res 2019;13:568-71.  |
| 2. | Bond M, Crathorne L, Peters J, Coelho H, Haasova M, Cooper C, et al. First do no harm: Pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis. BMC Anesthesiol 2016;16:81. |
| 3. | Standring S. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 41 st ed. London UK: Churchill Livingstone Elsevier; 2016. p. 776-893. |
| 4. | Welyczko N. Peripheral intravenous cannulation: Reducing pain and local complications. Br J Nurs 2020;29:S12-9. |
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