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Upper Extremity Nerve Blocks

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Essentials of Regional Anesthesia

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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 pragmatic and logical discussion of approaches and techniques for brachial plexus blockade.

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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  PubMed Central  Google Scholar 

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Acknowledgments

The authors thank Dr. Shubada Dugani for her invaluable help in acquiring the figures displayed in this chapter.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Montreal General Hospital, Montreal, QC, Canada

    De Q. H. Tran MD, FRCPC

  2. Department of Anesthesia, Pontificia Universidad Católica de Chile, Santiago, Metropolitana, Chile

    Maria Francisca Elgueta MD

  3. Department of Anesthesia and Pain Medicine, McGill University, Montreal, QC, Canada

    Juan Francisco Asenjo MD, FRCPC

Authors
  1. De Q. H. Tran MD, FRCPC
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  2. Maria Francisca Elgueta MD
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  3. Juan Francisco Asenjo MD, FRCPC
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Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

  3. Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Nalini Vadivelu

Review Questions

Review Questions

  1. 1.

    All the following nerves originate from the brachial plexus EXCEPT:

    1. (a)

      Thoracodorsal nerve

    2. (b)

      Intercostobrachial nerve

    3. (c)

      Lateral pectoral nerve

    4. (d)

      Long thoracic nerve

  2. 2.

    All the following nerves originate from the C5 nerve root EXCEPT:

    1. (a)

      Suprascapular nerve

    2. (b)

      Dorsal scapular nerve

    3. (c)

      Phrenic nerve

    4. (d)

      Ulnar nerve

  3. 3.

    An injury to the posterior cord will lead to all the following deficits EXCEPT:

    1. (a)

      Decreased shoulder abduction

    2. (b)

      Decreased elbow extension

    3. (c)

      Decreased sensation of the lateral aspect of the shoulder

    4. (d)

      Decreased sensation over the medial aspect of the forearm

  4. 4.

    For clavicular surgery, all the following blocks provide adequate postoperative analgesia EXCEPT:

    1. (a)

      Cervical paravertebral block

    2. (b)

      Supraclavicular block

    3. (c)

      Superficial cervical plexus block

    4. (d)

      None of the above

  5. 5.

    For shoulder surgery, all the following blocks provide adequate postoperative analgesia EXCEPT:

    1. (a)

      Infraclavicular combined with suprascapular nerve blocks

    2. (b)

      Infraclavicular combined with superficial cervical plexus blocks

    3. (c)

      Cervical paravertebral block

    4. (d)

      None of the above

  6. 6.

    For elbow surgery, all the following blocks provide adequate postoperative analgesia EXCEPT:

    1. (a)

      Infraclavicular block

    2. (b)

      Axillary block

    3. (c)

      Supraclavicular block

    4. (d)

      None of the above

  7. 7.

    For hand surgery, all the following blocks provide adequate postoperative analgesia EXCEPT:

    1. (a)

      Interscalene block

    2. (b)

      Humeral canal block

    3. (c)

      Supraclavicular block

    4. (d)

      None of the above

  8. 8.

    All the following are potential side effects of interscalene blocks EXCEPT:

    1. (a)

      Hoarseness

    2. (b)

      Exophthalmos

    3. (c)

      Myosis

    4. (d)

      Dyspnea

  9. 9.

    All the following are potential side effects of infraclavicular blocks EXCEPT:

    1. (a)

      Horner’s syndrome

    2. (b)

      Dyspnea

    3. (c)

      Winged scapula

    4. (d)

      Perioral numbness

  10. 10.

    All the following evoked motor responses are acceptable for neurostimulation-guided interscalene blocks EXCEPT:

    1. (a)

      Shoulder elevation

    2. (b)

      Pectoral contraction

    3. (c)

      Finger flexion

    4. (d)

      Wrist extension

  11. 11.

    All the following evoked motor responses are acceptable for neurostimulation-guided infraclavicular blocks EXCEPT:

    1. (a)

      Pectoral contraction

    2. (b)

      Elbow extension

    3. (c)

      Wrist extension

    4. (d)

      Finger flexion

  12. 12.

    Which of the following evoked motor responses is considered suboptimal in the performance of neurostimulation-guided axillary blocks?

    1. (a)

      Elbow flexion

    2. (b)

      Elbow extension

    3. (c)

      Thumb opposition

    4. (d)

      Wrist extension

  13. 13.

    With ultrasonography, all the following structures are hyperechoic EXCEPT:

    1. (a)

      Musculocutaneous nerve

    2. (b)

      Lateral cord

    3. (c)

      Superior trunk

    4. (d)

      Median nerve in the forearm

  14. 14.

    With ultrasonography, all the following structures are hypoechoic EXCEPT:

    1. (a)

      Inferior trunk

    2. (b)

      Phrenic nerve

    3. (c)

      C7 root

    4. (d)

      Medial cord

  15. 15.

    With ultrasonography, all the following nerves can be anesthetized using a perivascular injection EXCEPT:

    1. (a)

      Interscalene brachial plexus

    2. (b)

      Axillary brachial plexus

    3. (c)

      Median nerve at the elbow

    4. (d)

      Ulnar nerve at the wrist

Answers

  1. 1.

    b

  2. 2.

    d

  3. 3.

    d

  4. 4.

    c

  5. 5.

    b

  6. 6.

    d

  7. 7.

    a

  8. 8.

    b

  9. 9.

    c

  10. 10.

    a

  11. 11.

    a

  12. 12.

    b

  13. 13.

    c

  14. 14.

    d

  15. 15.

    a

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Tran, D.Q.H., Elgueta, M.F., Asenjo, J.F. (2018). Upper Extremity Nerve Blocks. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-74838-2_17

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  • DOI: https://doi.org/10.1007/978-3-319-74838-2_17

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  • Online ISBN: 978-3-319-74838-2

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