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Chapter 31F. Ultrasound-Guided Blocks at the Elbow

Which of the following statements is false regarding nerves that provide cutaneous supply to parts of the hand and wrist?

A. The ulnar nerve supplies sensation to both surfaces of the medial one-and-a-half fingers.

B. The median nerve supplies the sensation of the medial aspect of the palm, the palmar surface of the first three-and-a-half fingers, and the dorsal area of their tips.

C. The musculocutaneous nerve supplies sensation to the lateral antebrachial cutaneous nerve (one of its branches) and supplies sensation to the lateral forearm and wrist. It needs to be blocked separately by a subcutaneous wheal distal to the elbow if lateral wrist surgery is planned.

D. The radial nerve supplies the sensation of the posterior area of the arm and forearm. Distally the radial nerve supplies the dorsum of the hand, without the lateral three-and-a-half fingertips.

B is false, so option B is correct. The median nerve supplies the sensation of the lateral aspect of the palm, the palmar surface of the first three-and-a-half fingers, and the dorsal area of their tips.

A, C, and D are incorrect. All of these statements are true.

Which one of the following statements is true regarding ultrasound-guided blocks at the elbow?

A. The main indication for a forearm block is as a means of rescuing or supplementing an incomplete or failed proximal brachial plexus block.

B. The radial, median, and ulnar nerve can be blocked at only one location in the forearm.

C. The use of a tourniquet in forearm surgery is well tolerated when the radial, median, and ulnar nerve are blocked.

D. It is not necessary to completely surround the entire nerve in a circumferential pattern.

D is correct. It is unnecessary to completely surround the entire nerve in a circumferential pattern, although this can enhance the speed of block onset.

A is incorrect. The two main indications for a forearm block are a standalone technique for hand and/or wrist surgery and as a means of rescuing or supplementing an incomplete or failed proximal brachial plexus block.

B is incorrect. There are a variety of locations where a practitioner could approach each of these nerves, most of which are similar in efficacy.

C is incorrect. The use of a tourniquet, either on the arm or forearm, usually requires sedation and/or additional analgesia.

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