During the past 20 years, increasing knowledge in functional regional anesthesia anatomy, coupled with new technologies for locating peripheral nerves, has resulted in expansion of regional anesthesia techniques. This phenomenon served to provide the clinician with a wide variety of techniques from which to choose. Nevertheless, many nerve block techniques are quite similar and result in a similar, if not exact, distribution of anesthesia. The proper choice of the nerve block for a particular surgical procedure and/or patient, however, is far more important than deliberation on the minutia of various technical techniques. In this chapter, a rational selection of the nerve block techniques is approached in three sections. In the first section, indications for common nerve blocks are listed with a short summary of the advantages and disadvantages of each technique selected. In the second section, specific protocols for intraoperative anesthesia and postoperative analgesia for the common surgical procedures are suggested as practiced by anesthesiologists affiliated with the St. Luke's and Roosevelt Hospitals in New York. This cookbook approach was chosen to allow clinicians to duplicate the results that we have found, via trial and error, to work best in our own practice. The last section is a more comprehensive compendium of published medical literature on the indications for peripheral nerve blocks.
With the advent of ultrasound guidance for nerve blocks, the choice of which brachial plexus block to perform has become less relevant because the block can be extended by needle repositioning into the desired area. For example, the interscalene approach was not recommended in the past for procedures on the hand or elbow because it was believed that local anesthetic would not sufficiently cover the inferior trunk of the brachial plexus. However, this barrier can be overcome with the use of a low-interscalene approach or by using sonographic guidance to target all three trunks. Multiple injections at different levels of the brachial plexus through a single-needle insertion site can make the interscalene brachial plexus applicable for most upper limb procedures. Regardless, the common approaches to brachial plexus block are sufficiently different in their anesthetic coverage to deserve knowledgeable consideration when making a decision about which block to use. In addition to the anesthetic coverage, the block selection should also take into consideration other factors, such as patient comfort, preexisting respiratory dysfunction, and practitioner experience. Table 6-1 lists common nerve block procedures and their indications.
Table 6-1 Common Upper Limb Blocks
| Favorite Table
| Download (.pdf)
Table 6-1 Common Upper Limb Blocks
|PERIPHERAL NERVE BLOCK||INDICATIONS||ADVANTAGES||DISADVANTAGES|
|Interscalene brachial plexus block|
- Shoulder surgery
- Any surgery on the arm and humerus
- Manipulation of a frozen shoulder
- Also results in anesthesia of supraclavicular nerves
- Superficial, easy to perform, and comfortable for patient
- Hemidiaphragmatic paralysis
- Unless certain of inferior trunk blockade (by using US or a low-interscalene approach), not recommended for elbow, forearm, hand surgery
|Supraclavicular brachial plexus ...|
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessAnesthesiology Full Site: One-Year Subscription
Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more
Pay Per View: Timed Access to all of AccessAnesthesiology
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.