These blocks are usually performed to decrease tourniquet pain and augment a brachial plexus block. Fibers from the C8 and T1 nerve roots form the medial cutaneous nerve. Fibers of the second intercostal nerve form the intercostobrachial nerve that has communication with the median cutaneous nerve. Both of these nerves exit the axilla outside the brachial plexus sheath parallel to the triceps muscle.
Arrange sterile towels, sterile gloves, gauze pads, marking pen, antiseptic solution, syringes, and needles for local infiltration and nerve block placement.
5-10 ml syringes of local anesthetic. Needles
21 g 4 in. needle for skin infiltration.
3% chloroprocaine, 2% lidocaine, 0.5% ropivacaine, 0.5% bupivacaine.
To block the intercostobrachial and medial cutaneous nerve, have the patient positioned supine and the operative arm abducted 90°. The anterior axillary line and superior margin of the biceps muscle are identified. Then following aseptic technique, a needle is inserted in full length (4 in.) at this point and placed subcutaneously, directed from the biceps to the triceps muscle. Subsequent to negative aspiration, 5-10 cc of local anesthetic is injected as the block needle is being withdrawn creating a subcutaneous skin wheal.
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