Sensory Distribution of the Lateral Cutaneous Nerve of Forearm After Ultrasound-Guided Block: Potential Implications for Thumb-Base Surgery.

Surgery of the wrist and hand commonly involves regional anesthesia of the median nerve and superficial radial nerve within the forearm. In this sonographic study, the contribution of the lateral cutaneous nerve of forearm (LCNF) to thumb cutaneous sensation was studied. Patients scheduled for thumb suspension arthroplasty (n = 35) were examined by ultrasound, with LCNF, median nerve, and superficial radial nerve identified. A single nerve was then injected with local anesthetic, and the area of cutaneous sensory loss mapped at 15 minutes. The remaining 2 nerves were then blocked for progression to theater. In 15 patients, the LCNF was blocked first at the antecubital fossa, where it was located posterior to the cephalic vein 9.1 (1.6) mm distal to the interepicondylar line. Bifurcation occurred further distally, 18 (2.6) mm from the interepicondylar line. In 14 of 15 cases, LCNF sensory distribution extended to the thumb base, 8.3 (7.8) mm distal to the radiocarpal joint. This study has demonstrated the LCNF to innervate the thumb base, indicating neural blockade of this nerve may be required for surgery of the basal thumb joint. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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