title: A cadaveric study comparing the three approaches for ulnar nerve block at wrist.
abstract: BACKGROUND
  Ulnar nerve blockade as a component of wrist block is a promising technique for adequate anesthesia and analgesia for different surgeries of the hand. Due to anatomical variations in the location of ulnar nerve under the flexor carpi ulnaris (FCU) a technique with good results and minimal complications are required.
  
  
  OBJECTIVE
  The aim of the following study is to compare the three techniques (volar, transtendinous volar [TTV] and ulnar) for ulnar nerve block at the wrist in human cadaveric wrists.
  
  
  METHODS
  Our study was conducted using 40 cadaver wrists. After inserting standard hypodermic needles by three techniques for ulnar nerve blockade at the wrist, a detailed dissection of FCU was done. The mean distance from the tip of the needle to ulnar artery/nerve and number of instances in which the ulnar artery/nerve pierced were observed.
  
  
  RESULTS
  Inter-group statistical significance was observed in measurement of the mean distance (mm) from the tip of the needle to the ulnar artery (volar [0.92 ± 0.11], TTV [3.96 ± 0.14] and ulnar [7.14 ± 0.08] approaches) and ulnar nerve (volar/TTV/ulnar approaches were 0.71 ± 0.12/3.61 ± 0.10/6.31 ± 0.49, respectively) (P = 0.001). Inadvertent intra-arterial/intraneural injections was seen with volar approach in 14 (35%) and 16 (40%) of the cadaveric wrists respectively, statistically significant with transtendinous and ulnar techniques of ulnar nerve block.
  
  
  CONCLUSIONS
  TTV approach could be a better technique of choice for ulnar nerve blockade at the wrist because of its ease to practice, safer profile and minimum chances of inadvertent intra-arterial/intraneural injection with adequate anesthesia/analgesia.
authors.affiliation: Department of Anesthesia, Teerthanker Mahaveer Medical College, Moradabad, Uttar Pradesh, India.
authors.forename: Rohit
authors.initials: R
authors.lastname: Varshney
authors.affiliation: Department of Anatomy, Teerthanker Mahaveer Medical College, Moradabad, Uttar Pradesh, India.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Sharma
authors.affiliation: Department of Anesthesia, Max Super Speciality Hospital, Saket, New Delhi, India.
authors.forename: Shraddha
authors.initials: S
authors.lastname: Malik
authors.affiliation: Department of Anesthesia, Rajiv Gandhi Cancer Hospital Institute and Research Centre, Rohini, New Delhi, India.
authors.forename: Sunny
authors.initials: S
authors.lastname: Malik
keywords: Ulnar nerve; ulnar nerve block; wrist block