Lower extremity block anatomy
Key points • Unlike the upper extremity, there are two nerve plexuses innervating the lower extremity; the lumbar plexus innervates the ventral aspect, whereas the lumbosacral plexus primarily innervates the…
Intravenous regional block
Key points • Intravenous (IV) regional anesthesia is usually achieved using dilute lidocaine 0.5%; 50 mL of prilocaine has also been used successfully. • The IV regional block is useful…
Distal upper extremity blocks
Key points • Blockade of peripheral nerves of the upper extremity is often accomplished by brachial plexus approaches. However, conditions such as infections to brachial plexus sites, coagulopathy, single nerve…
Axillary block
Perspective Axillary brachial plexus block is most effective for surgical procedures distal to the elbow. Some patients can undergo procedures on the elbow or lower humerus with an axillary technique,…
Infraclavicular block
Perspective Infraclavicular brachial plexus block is useful for both single-injection and continuous infusion techniques. This technique results in a sensory and motor block similar to a traditional axillary approach, albeit…
Supraclavicular block
Perspective Supraclavicular block provides anesthesia of the entire upper extremity in the most consistent, efficient manner of any brachial plexus technique. It is the most effective block for all portions…
Suprascapular block
Key Points • High-frequency, 38-mm broadband linear array transducer is preferred for this block. • For catheter insertion, the Tuohy needle is usually used. The catheter is placed beneath the…
Interscalene block
Perspective Interscalene block (classic anterior approach) is especially effective for surgery of the shoulder or upper arm because the roots of the brachial plexus are most easily blocked with this…
Equipment and ultrasound
Equipment Needles, catheters, and syringes Effective regional anesthesia requires comprehensive knowledge of equipment—that is, the needles, syringes, and catheters that allow the anesthetic to be injected into the desired area….
Upper extremity block anatomy
Key Points • Along its course above the clavicle, the brachial plexus is bounded by the anterior and middle scalene muscles. The two muscles constitute the scalene triangle with its…
