Skip to main content
SpringerLink
Log in

Upper Extremity Nerve Blocks

  • Chapter
  • First Online:
Book cover Essentials of Regional Anesthesia

Abstract

For more than a century, brachial plexus blockade has been an indispensable tool in the regional anesthesiologist’s armamentarium. By providing surgical anesthesia and postoperative analgesia to the entire upper limb, it has been intimately linked to advances in orthopedic and ambulatory anesthesia. Furthermore, with the advent of ultrasonography, upper extremity blocks are being rediscovered under a new light. Every month, anesthesia journals report novel methods to anesthetize different parts of the brachial plexus. Navigating this plethora of studies can be a daunting task. This chapter aims to present a concise discussion of approaches and techniques for brachial plexus blockade based on available evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Boezaart AP. That which we call a rose by any other name would smell as sweet – and its thorns would hurt as much. Reg Anesth Pain Med. 2009;34:3–7.

    Article  PubMed  Google Scholar 

  2. Rettig HC, Gielen MJM, Jack NTM, Boersma E, Klein J. A comparison of the lateral and posterior approach for brachial plexus block. Reg Anesth Pain Med. 2006;31:119–26.

    PubMed  Google Scholar 

  3. Dewees JL, Schultz CT, Wilkerson FK, Kelly JA, Biegner AR, Pellegrini JE. Comparison of two approaches to brachial plexus anesthesia for proximal upper extremity surgery: interscalene and intersternocleidomastoid. AANA J. 2006;74:201–6.

    PubMed  Google Scholar 

  4. Deleuze A, Gentili M, Marret E, Lamonerie L, Bonnet F. A comparison of a single-stimulation lateral infraclavicular plexus block with a triple-stimulation axillary block. Reg Anesth Pain Med. 2003;28:89–94.

    PubMed  Google Scholar 

  5. Koscielniak-Nielsen ZJ, Rasmussen H, Hesselbjerg L, Nielsen TP, Gurkan Y. Infraclavicular block causes less discomfort than axillary block in ambulatory patients. Acta Anaesth Scand. 2005;49:1030–4.

    Article  PubMed  CAS  Google Scholar 

  6. Minville V, Fourcade O, Idabouk L, et al. Infraclavicular brachial plexus block versus humeral block in trauma patients: a comparison of patient comfort. Anesth Analg. 2006;102:912–6.

    Article  PubMed  Google Scholar 

  7. Tran DQH, Russo GL, Munoz L, Zaouter C, Finlayson RJ. A prospective, randomized comparison between ultrasound-guided supraclavicular, infraclavicular and axillary brachial plexus blocks. Reg Anesth Pain Med. 2009;34:366–71.

    Article  Google Scholar 

  8. Liguori GA, Zayas VM, YaDeau JT, et al. Nerve localization techniques for interscalene brachial plexus blockade: a prospective, randomized comparison of mechanical paresthesia versus electrical stimulation. Anesth Analg. 2006;103:761–7.

    Article  PubMed  Google Scholar 

  9. Smith BL. Efficacy of a nerve stimulator in regional anesthesia; experience in resident training programme. Anaesth. 1976;31:778–82.

    Article  CAS  Google Scholar 

  10. Boezaart A, de Beer J, du Toit C, van Rooyen K. A new technique of continuous interscalene nerve block. Can J Anesth. 1999;46:275–81.

    Article  PubMed  CAS  Google Scholar 

  11. Kapral S, Greher M, Huber G, et al. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med. 2008;33:253–8.

    PubMed  Google Scholar 

  12. Liu SS, Zayas VM, Gordon MA, et al. A prospective, randomized, controlled trial comparing ultrasound versus nerve stimulator guidance for interscalene block for ambulatory shoulder surgery for postoperative neurological symptoms. Anesth Analg. 2009;109:265–71.

    Article  PubMed  Google Scholar 

  13. Sites BD, Neal JM, Chan V. Ultrasound in regional anesthesia: where should the “focus” be set? Reg Anesth Pain Med. 2009;34:531–3.

    Article  PubMed  Google Scholar 

  14. Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg. 1991;72:498–503.

    Article  PubMed  CAS  Google Scholar 

  15. Urmey WF, Gloeggler PJ. Pulmonary function changes during interscalene brachial plexus block: effects of decreasing local anesthetic injection volume. Reg Anesth. 1993;18:244–9.

    PubMed  CAS  Google Scholar 

  16. Urmey WF, Grossi P, Sharrock N, Stanton J, Gloeggler PJ. Digital pressure during interscalene block is clinically ineffective in preventing anesthetic spread to the cervical plexus. Anesth Analg. 1996;83:366–70.

    PubMed  CAS  Google Scholar 

  17. Bennani SE, Vandenabele-Teneur F, Nyarwaya JB, Delecroix M, Krivosic-Horber R. An attempt to prevent spread of local anesthetic to the phrenic nerve by compression above the injection site during interscalene brachial plexus block. Eur J Anaesth. 1998;15:453–6.

    CAS  Google Scholar 

  18. Sala-Blanch X, Lazaro JR, Correa J, Gomez-Fernandez M. Phrenic nerve block caused by interscalene brachial plexus block: effects of digital pressure and a low volume of local anesthetic. Reg Anesth Pain Med. 1999;24:231–5.

    Article  PubMed  CAS  Google Scholar 

  19. Al-Kaisy AA, Chan VWS, Perlas A. Respiratory effects of low-dose bupivacaine interscalene block. Br J Anaesth. 1999;82:217–20.

    Article  PubMed  CAS  Google Scholar 

  20. Riazi S, Carmichael N, Awad I, Hotby RM, McCartney CJL. Effect of local anesthetic volume (20 vs 5 mL) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. Br J Anaesth. 2008;101:549–56.

    Article  PubMed  CAS  Google Scholar 

  21. Boezaart AP, de Beer JF, Nell ML. Early experience with continuous cervical paravertebral block using a stimulating catheter. Reg Anesth Pain Med. 2003;28:406–13.

    PubMed  Google Scholar 

  22. Brown DL, Cahill DR, Bridenbaugh D. Supraclavicular nerve block: anatomic analysis of a method to prevent pneumothorax. Anesth Analg. 1993;76:530–4.

    Article  PubMed  CAS  Google Scholar 

  23. Franco CD, Domashevich V, Voronov G, Rafizad AB, Jelev TJ. The supraclavicular block with a nerve stimulator: to decrease or not to decrease, that is the question. Anesth Analg. 2004;98:1167–71.

    Article  PubMed  Google Scholar 

  24. Soares LG, Brull R, Lai J, Chan VW. Eight ball, corner pocket: the optimal needle position for ultrasound-guided supraclavicular block. Reg Anesth Pain Med. 2007;32:94–5.

    PubMed  Google Scholar 

  25. Renes SH, Spoormans HH, Gielen MH, Rettig HC, van Geffen JG. Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2009;34:595–9.

    Article  PubMed  Google Scholar 

  26. Duggan E, El Beheiry H, Perlas A, et al. Minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2009;34:215–8.

    Article  PubMed  CAS  Google Scholar 

  27. Knoblanche GE. The incidence and aetiology of phrenic nerve blockade associated with supraclavicular brachial plexus block. Anaesth Intens Care. 1979;7:346–9.

    CAS  Google Scholar 

  28. Rodriguez J, Taboada M, Oliveira J, et al. Single-stimulation of the posterior cord is superior to dual nerve stimulation in a coracoid block. Acta Anaesthesiol Scand. 2010;54:241–5.

    Article  PubMed  CAS  Google Scholar 

  29. Tran DQH, Bertini P, Zaouter C, Munoz L, Finlayson RJ. A prospective, randomized comparison between single- and double-injection ultrasound-guided infraclavicular brachial plexus block. Reg Anesth Pain Med. 2010;35:16–21.

    Article  PubMed  Google Scholar 

  30. Desgagnes MC, Levesque S, Dion S, et al. A comparison of a single or triple injection technique for ultrasound-guided infraclavicular block: a prospective randomized controlled study. Anesth Analg. 2009;109:668–72.

    Article  PubMed  Google Scholar 

  31. Sauter AR, Dodgson MS, Stubhaug A, Halstensen AM, Klaastad O. Electrical nerve stimulation or ultrasound guidance for lateral sagittal infraclavicular blocks: a randomized, controlled, observer-blinded, comparative study. Anesth Analg. 2008;106:1910–5.

    Article  PubMed  CAS  Google Scholar 

  32. Taboada M, Rodriguez J, Amor M, et al. Is ultrasound guidance superior to conventional nerve stimulation for coracoid infraclavicular brachial plexus block? Reg Anesth Pain Med. 2009;34:357–60.

    Article  PubMed  Google Scholar 

  33. Brull R, Lupu M, Perlas A, Chan VWS, McCartney CJL. Compared with nerve stimulation, ultrasound guidance shortens the time for infraclavicular block performance. Can J Anesth. 2009;56:812–8.

    Article  PubMed  Google Scholar 

  34. Dingemans E, Williams SR, Arcand G, et al. Neurostimulation in ultrasound-guided infraclavicular block: a prospective randomized trial. Anesth Analg. 2007;104:1275–80.

    Article  PubMed  Google Scholar 

  35. Gurkan Y, Tekin M, Acar S, Solak M, Toker K. Is nerve stimulation needed during an ultrasound-guided lateral sagittal infraclavicular block? Acta Anaesthesiol Scand. 2010;54:403–7.

    Article  PubMed  CAS  Google Scholar 

  36. Raj PP, Montgomery SJ, Nettles D, Jenkins MT. Infraclavicular brachial plexus block – a new approach. Anesth Analg. 1973;52:897–904.

    Article  PubMed  CAS  Google Scholar 

  37. Wilson JL, Brown DL, Wong GY, et al. Infraclavicular brachial plexus block: parasagittal anatomy important to the coracoid technique. Anesth Analg. 1998;87:870–3.

    PubMed  CAS  Google Scholar 

  38. Stadlmeyer W, Neubauer J, Finkl RO, Groh J. Unilateral phrenic paralysis after vertical infraclavicular plexus block [German]. Anaesthetist. 2000;49:1030–3.

    Article  CAS  Google Scholar 

  39. Crews JC, Gerancher JC, Wellers RS. Pneumothorax after coracoid infraclavicular brachial plexus block. Anesth Analg. 2007;105:275–7.

    Article  PubMed  Google Scholar 

  40. Tran DQH, Clemente A, Doan J, Finlayson RJ. Brachial plexus blocks: a review of approaches and techniques. Can J Anesth. 2007;54:662–74.

    Article  PubMed  Google Scholar 

  41. Sia S, Bartoli M. Selective ulnar nerve localization is not necessary for axillary brachial plexus block using a multiple nerve stimulation technique. Reg Anesth Pain Med. 2001;26:12–6.

    Google Scholar 

  42. Sia S. A comparison of injection at the ulnar and the radial nerve in axillary block using triple stimulation. Reg Anesth Pain Med. 2006;31:514–8.

    PubMed  Google Scholar 

  43. Sia S, Lepri A, Magherini M, Doni L, Di Marco P, Gritti G. A comparison of proximal and distal radial nerve motor responses in axillary block using triple stimulation. Reg Anesth Pain Med. 2005;30:458–63.

    Google Scholar 

  44. Chan VWS, Perlas A, McCartney CJL, Brull R, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anesth. 2007;54:176–82.

    Article  PubMed  Google Scholar 

  45. Casati A, Danelli G, Baciarello M, et al. A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology. 2007;106:992–6.

    Article  PubMed  CAS  Google Scholar 

  46. O’Donnell BD, Iohom G. An estimation of the minimum anesthetic volume of 2% lidocaine in ultrasound-guided axillary brachial plexus block. Anesthesiology. 2009;111:25–9.

    Article  PubMed  Google Scholar 

  47. Carles M, Pulcini A, Macchi P, Duflos P, Raucoules-Aime M, Grimaud D. An evaluation of the brachial plexus block at the humeral canal using a neurostimulator (1417 patients): the efficacy, safety, and predictive criteria of failure. Anesth Analg. 2001;92:194–8.

    Article  PubMed  CAS  Google Scholar 

  48. Peng PWH, Wiley MJ, Liang J, Bellingham GA. Ultrasound-guided suprascapular nerve block: a correlation with fluoroscopic and cadaveric findings. Can J Anesth. 2010;57:143–8.

    Article  PubMed  Google Scholar 

  49. Fredrickson MJ, Ball CM, Dagleish AJ, Stewart AW, Short TG. A prospective randomized comparison of ultrasound and neurostimulation as needle end points for interscalene catheter placement. Anesth Analg. 2009;108:1695–700.

    Article  PubMed  Google Scholar 

  50. Dhir S, Ganapathy S. Comparative evaluation of ultrasound-guided continuous infraclavicular brachial plexus block with stimulating catheter and traditional technique: a prospective-randomized trial. Acta Anaesthesiol Scand. 2008;52:1158–66.

    Article  PubMed  CAS  Google Scholar 

  51. Mariano ER, Loland VJ, Sandhu NS, et al. A trainee-based randomized comparison of stimulating interscalene perineural catheter with a new technique using ultrasound guidance alone. J Ultrasound Med. 2010;29:329–36.

    PubMed  Google Scholar 

  52. Mariano ER, Loland VJ, Bellars RH, et al. Ultrasound guidance versus electrical stimulation for infraclavicular brachial plexus perineural catheter insertion. J Ultrasound Med. 2009;28:1211–8.

    PubMed  Google Scholar 

  53. Ficarotta MR, Morey TE, Boezaart AP. Does “Opening the Perineural Space” before stimulating catheter placement for continuous nerve block add value in clinical practice? Reg Anesth Pain Med. 2010;35:245–8.

    Article  Google Scholar 

  54. Tran DQH, De La Cuadra Fontaine JC, Chan SY, Kovarik G, Asenjo JF, Finlayson RJ. Coiling of stimulating perineural catheters. Anesthesiology. 2007;106:189–90.

    Article  PubMed  Google Scholar 

  55. Sauter AR, Smith HJ, Stubhaug A, et al. Use of magnetic resonance imaging to define the anatomical location closest to all three cords of the infraclavicular brachial plexus. Anesth Analg. 2006;103:1574–6.

    Article  PubMed  Google Scholar 

  56. Tran DQH, Charghi R, Finlayson RJ. The “Double Bubble” sign for successful infraclavicular brachial plexus blockade. Anesth Analg. 2006;103:1048–9.

    Article  Google Scholar 

  57. Loubert C, Williams SR, Helie F, Arcand G. Complication during ultrasound-guided regional block: accidental intravascular injection of local anesthetic. Anesthesiology. 2008;108:759–60.

    Article  PubMed  Google Scholar 

Suggested Reading

  • Tran DQH, Clemente A, Doan J, Finlayson RJ. Brachial plexus blocks: a review of approaches and techniques. Can J Anesth. 2007;54:662–74.

    Article  PubMed  Google Scholar 

  • Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJL, Franco CD, et al. Upper extremity regional anesthesia- essentials of our current understandings 2008. Reg Anesth Pain Med. 2009;34:134–70.

    Article  PubMed  Google Scholar 

  • McCartney CJL, Lin L, Shastri U. Evidence basis for the use of ultrasound for upper-extremity blocks. Reg Anesth Pain Med. 2009;35:S10–5.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia, Montreal General Hospital, McGill University, 1650 Avenue Cedar, D10-144, Montreal, Quebec, H3G-1A4, Canada

    De Q. H. Tran MD, FRCPC, Shubada Dugani MBBS, FRCA & Juan Francisco Asenjo MD

Authors
  1. De Q. H. Tran MD, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shubada Dugani MBBS, FRCA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juan Francisco Asenjo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to De Q. H. Tran MD, FRCPC .

Editor information

Editors and Affiliations

  1. University Hosp and Ochsner Kenner Hosp, Prof and Chairman,Dept of Anesthesiology, Director of Interventional Pain Mgmt., Louisiana State University School of Medicine, New Orleans, 70112, USA

    Alan David Kaye

  2. Harvard Medical School, Director, Proced Sedation Mgmt & Safety, Assistant Professor of Anesthesia, Anesthesiology, Perioperative & Pain Med, Boston, 02115, USA

    Richard D. Urman

  3. Yale University School of Medicine, Associate Professor of Anesthesiology, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Tran, D.Q.H., Dugani, S., Asenjo, J.F. (2012). Upper Extremity Nerve Blocks. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1013-3_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-1013-3_13

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-1012-6

  • Online ISBN: 978-1-4614-1013-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation