Time out, confirm correct patient and laterality
Apply topical anesthesia if needed
Draw up 5-10 mL of anesthetic into syringe
Beware of toxic dose of anesthetic you're using Local Anesthetic Systemic Toxicity (LAST)
Before any nerve block, perform neurovascular exam (often includes 2 patient discrimination with paperclip)
Beware of toxic dose of anesthetic you're using Local Anesthetic Systemic Toxicity (LAST)<unk>  nerve is within the carpal tunnel
Between palmaris longus and flexor carpi radialis
Insert needle perpendicular between tendons, 2-3 cm proximal to the distal crease of the wrist
Aspirate; if no blood inject a few mL's of anesthetic slowly
Test sensation to pain distal to block
Cleanse the skin overlying the antecubital fossa with chosen antiseptic
Create a sterile field using sterile drape
In a sterile fashion, apply a small wheel of local anesthetic to the area immediately proximal to the antecubital fossa
Palpate the brachial artery to be aware of its path
The<unk>  nerve should be approximately 1 cm<unk>  to the brachial artery at this point
Insert the needle approximately 1-2 cm proximal to the flexor crease and advance with negative pressure applied to the syringe
At 1-2 cm deep, aspirate prior to injection to rule out intravascular placement
Inject 5-10 mL of local anesthetic
The<unk>  nerve should be approximately 1 cm<unk>  to the brachial artery at this point
Place a linear probe on the volar aspect of the midforearm
It may be easier to find the nerve by starting with the probe over the volar wrist and sliding proximally.  The tendons will disappear as they become muscles but the nerve will remain as the only continuous round structure.
The<unk>  nerve  takes the appearnce of a "chocolate chip cookie" in the axial orientation and lies between the flexor digitorum profundus and supeficialis
Clean and prep the patient's arm under sterile conditions, and insert a 25 g needle in the long axis under ultrasound guidance next to the nerve
Aspirate to prevent inadvertent intravascular injection
Inject 5 mL of local anesthetic so that it basks the nerve
It may be easier to find the nerve by starting with the probe over the volar wrist and sliding proximally.  The tendons will disappear as they become muscles but the nerve will remain as the only continuous round structure.
Nerve Block: Median
Nerve Block: Penile
Nerve Block: Mental
Nerve Block: Occipital
Nerve Block: Femoral
Nerve Block: Foot
Nerve Block: Upper Extremity
Nerve block: Auricular