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 for procedures lasting 90–120 minutes. This time limit is due to tourniquet…
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 distribution, minor procedures (not requiring a tourniquet), and rescue supplementations of…
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, but strong consideration should be given to a supraclavicular 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 with certain advantages. Thus it is most useful for patients…
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 transverse scapular ligament around the suprascapular nerve (SSN). The correct position of…
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 of the upper extremity and is carried out at the…
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 technique. Frequently the ulnar nerve and its more peripheral distribution…
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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. In early years, regional anesthesia found many variations in the…
Key Points Neonates and infants are more prone to developing systemic toxicity to local anesthetics (LAs), particularly amide LAs, compared with older children and adults. This is due to reduced plasma concentration of α 1 -acid glycoprotein with higher unbound…