Background and aims In hand and wrist surgery, wide-awake surgery is favored for simultaneous evaluation of active joint movement and surgical correction. Ultrasound-guided sensory selective peripheral nerve block (SSPNB) can provide safe and reproducible wide-awake anesthesia to more invasive or extensive surgeries.

Methods A 57-year-old male patient was diagnosed with right distal radioulnar joint arthritis and ulnar impaction syndrome. Sauve-Kapandji operation was performed under the infraclavicular brachial plexus block (BPB). The procedure was completed, he complained of clicking in his right wrist particularly during supination and pronation. Corrective surgery was performed under infraclavicular BPB only to result in persisted snapping and request another correction. The surgeon required an anesthesia modality to preserve the supination during the surgery. Ultrasound-guided SSPNB was planned. First, cutaneous sensory nerves of the medial forearm were individually examined and blocked; the medial and posterior antebrachial cutaneous nerves, and the sensory branches of the ulnar nerve and the median nerve. Additionally, the posterior and anterior interosseous nerves were independently blocked to maintain analgesia of the interosseous membrane.

Results Cold and pain sensation were evaluated to confirm the acceptability of the surgical anesthesia and the patient was asked to flip his palm facing up and down to ensure his full range of motion was practiced and the problematic clicking was represented. The surgical procedure was performed successfully monitoring the patient’s active supination-pronation.

Conclusions Our study supported the adequacy of the ultrasound guided selective sensory nerve block by exercising it to more invasive surgery involving osteotomy with larger surgical field proximal to the wrist joint.