A critical assessment of supraclavicular brachial plexus block

Low interscalene block provides reliable anesthesia for surgery at or about the elbow

STUDY OBJECTIVE

To determine whether interscalene brachial plexus block (ISB) provides adequate anesthesia for surgery on or about the elbow.

STUDY DESIGN

Case series.

SETTING

Operating room of an academic teaching hospital.

PATIENTS

78 patients scheduled for elective elbow surgery.

INTERVENTIONS

All patients received an ISB using a low approach technique. A stimulating needle was inserted in the interscalene groove two cm above the clavicle. A volume of 35-45 mL of mepivacaine 1.5% or ropivacaine 0.5% was administered after obtaining a motor response of any component of the brachial plexus with a current intensity of 0.2-0.4 mA (0.1 msec).

MEASUREMENTS

Block success rate, defined as the ability to complete surgery without use of intraoperative opioids or general anesthesia, was assessed. Verbal rating scores for pain (0 = no pain, 10 = worst pain imaginable) were obtained in the recovery room.

MAIN RESULTS

Low ISB resulted in successful surgical anesthesia in 75 (96%) of the study patients. Verbal rating scores were low (0-2) for all patients postoperatively.

CONCLUSIONS

The low interscalene block can be used to provide surgical anesthesia in the majority of patients having surgery on or about the elbow.

Brachial Plexus Anaesthesia for Upper Limb Surgery: A Review of Eight Years’ Experience

1248 supraclavicular brachial plexus blocks and 665 axillary plexus blocks were administered to 1913 patients undergoing upper limb surgery. Plexus block alone was successful in 83.5%. In a further 11.4% of cases, adequate anaesthesia was obtained following augmentation by other regional or local techniques. This resulted in an overall success rate of 94.9% and general anaesthesia was required in only 5.1%. The two percutaneous approaches to the brachial plexus did not differ in their success-rates but clinically apparent pneumothorax occurred in 0.8% of supraclavicular blocks.

Brachial plexus block anaesthesia is recommended as a safe and satisfactory alternative to general anaesthesia for upper limb surgery.

Paresthesiae or no paresthesiae? Nerve lesions after axillary blocks

Seeking paresthesiae when performing a peripheral nerve block may increase the risk of post-anesthetic neurological sequelae. To test this hypothesis, we prospectively followed two groups of patients who underwent hand surgery with an axillary block. In one group, the axillary plexus was located by actively seeking paresthesiae; in the other, pulsations of the axillary artery indicated an adequate position of the injection needle. Mepivacaine 10 mg/ml, with or without adrenaline, was used. The study included 533 patients, 290 in the paresthesia group and 243 in the artery group. Although unintentional, paresthesiae were elicited in 40% of patients in the artery group. Postanesthetic nerve lesions were seen in ten patients, eight in the paresthesia group and two in the artery group, all of whom had been blocked by mepivacaine with adrenaline. Symptoms varied between light paresthesiae lasting a few weeks, and severe paresthesiae, ache and paresis lasting more than 1 year. The etiology suspected was needle and perhaps injection trauma to the nerves during blocking. We conclude that whenever possible nerve blocks should be performed without searching for paresthesiae.

Capsule anesthesiology: use of local anesthetics in dermatology

This paper, the third of three articles, discusses the basic techniques of administering local anesthetics to the scalp, face, and neck.