RAPTIR Block for Elbow Dislocation

While the appearance of the dislocated elbow on x-ray is fairly obvious, take a look at how it appears on ultrasound. The linear transducer was placed on the dorsal aspect of the distal upper arm and oriented in the long axis. In the pre-reduction ultrasound, appreciate the proximity of the olecranon to the near-field and notice the change in its distance to the humerus in the post-reduction imaging.

With proper training, reduction under regional anesthesia is a great alternative to procedural sedation. While the infraclavicular brachial plexus block could provide proper anesthesia to the elbow, the steep angle required in this approach to access the axillary sheath below the axillary artery adds a layer of technical difficulty. In the RAPTIR (Retrograde Approach to the Infraclavicular Region) block, the transducer is held infraclavicular while the needle approach is supraclavicular, and the needle is carefully advanced past a “blind spot” from clavicular shadowing until it is visualized on the ultrasound screen.

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