Distal upper extremity blocks

Distal upper extremity blocks are a useful and safe alternative for wrist and hand surgeries, not only as a supplement of more proximal incomplete blocks (eg, infraclavicular), but as a regional anesthetic technique by itself when an upper arm tourniquet is not necessary. Using nerve-stimulation for identifying peripheral nerves at the elbow and wrist increases the blocks’ efficacy and reduces neurological injury. As most of the peripheral nerves at this level are located in sites where the nerve branch is contained within bony and ligamentous structures, it is very important to avoid excessive pressure when injecting the local anesthetic solution in order to prevent nerve injury.