Brachial plexus anesthesia

Borgeat A, Ekatodramis G, Blumenthal S. Interscalene brachial plexus anesthesia with ropivacaine 5 mg/mL and bupivacaine 5 mg/mL effects on electrocardiogram. Reg Anesth Pain Med. 2004 29 557-563. 

The addition of fentanyl 1 pg/ml to ropivacaine 7.5 mg/ml did not improve nerve blockade by axillary brachial plexus anesthesia in a double-blind, randomized study in 30 patients undergoing orthopedic procedures (31). In another double-blind, randomized study, 60 patients receiving axillary brachial plexus blockade were given 0.25% bupivacaine 40 mg, 0.25% bupivacaine 40 mg plus fentanyl 2.5 pg/ml, or 0.125% bnpivacaine 40 mg plus fentanyl 2.5 pg/ml (32). The addition of fentanyl 2.5 pg/ml prolonged sensory and motor blockade without any improvement in the onset of anesthesia and no significant increase in adverse effects. These two studies have reaffirmed the current position of conflicting results in studies of the benefits of adding fentanyl to local anesthetics for peripheral nerve blockade. 

Brachial plexus anesthesia Buccal anesthesia Caudal anesthesia Cervical plexus anesthesia Dental anesthesia Digital anesthesia Epidural anesthesia Intercostal nerve anesthesia Interpleural anesthesia Intra-articular anesthesia Intradermal anesthesia Intrathecal (spinal) anesthesia Intravenous regional anesthesia Laryngeal anesthesia Lumbar plexus anesthesia Nasal anesthesia Neck anesthesia Obstetric anesthesia Ocular anesthesia Oropharyngeal anesthesia Otic anesthesia Paravertebral anesthesia Perianal anesthesia Peritonsillar anesthesia Respiratory anesthesia Sciatic nerve anesthesia Stellate ganglion anesthesia... 

The systemic complications of brachial plexus anesthesia are similar to those seen with others if sufficient drug enters the circulation. Injections outside the axillary sheath result in higher plasma concentrations of local anesthetic than intrasheath injection (SEDA-22, 135). However, several other complications are specific to this route. Local complications include hematoma and infection. Horner s syndrome, temporary phrenic nerve blockade, and peripheral neuropathies have been reported (SEDA-18,142). 

Inadvertent injection into the subarachnoid space, occasionally causing cerebral or neurological problems, is a life-threatening complication of brachial plexus anesthesia. It can also cause postdural puncture headache (SEDA-21, 131). 

The respiratory depressant and gastrointestinal adverse effects of remifentanil have been observed in a randomized, single-blind study of 125 patients undergoing elective orthopedic and urological surgery under spinal or brachial plexus anesthesia (16). They were randomized to either remifentanil (a bolus of 0.5 micrograms/kg plus an infusion of 0.1 micrograms/kg/minute) or propofol... 

A conduction block is a type of regional anesthesia produced by injection of a local anesthetic drug into or near a nerve trunk. Examples of a conduction block include an epidural block (injection of a local anesthetic into the space surrounding the dura of the spinal cord) a trails sacral (caudal) block (injection of a local anesthetic into the epidural space at the level of the sacrococcygeal notch) and brachial plexus block (injection of a local anesdietic into the brachial plexus). Epidural, especially, and trailssacral blocks are often used in obstetrics. A brachial plexus block may be used for surgery of the arm or hand. 

Regional block, a form of anesthesia that includes spinal and epidural anesthesia, involves injection near a nerve or nerve plexus proximal to the surgical site. It provides excellent anesthesia for a variety of procedures. Brachial plexus block is commonly used for the upper extremity. Individual blocks of the sciatic, femoral, and obturator nerves can be used for the lower extremity. An amount that is close to the maximally tolerated dose is required to produce blockade of a major extremity. 

Peripheral nerve block. The anesthetic is injected close to the nerve trunk so that transmission along the peripheral nerve is interrupted.61 This type of local anesthesia is common in dental procedures (restorations, tooth extractions, and so on) and can also be used to block other peripheral nerves to allow certain surgical procedures of the hand, foot, shoulder, and so forth. ii.56.65 xnjection near larger nerves (femoral, sciatic) or around a nerve plexus (brachial plexus)... 

Karakaya D, Buyukgoz F, Baris S, Guldogus F, Tur A. Addition of fentanyl to bupivacaine prolongs anesthesia and analgesia in axUlaiy brachial plexus block. Reg Anesth Pain Med 2001 26(5) 434-8. 

A 60-year-old 70 kg woman with a fractured radius had an axillary brachial plexus block for postoperative analgesia after uneventful general anesthesia (5). A 50 mm insulated regional block needle attached to a nerve stimulator was used to locate the brachial plexus, and after negative aspiration, levobupivacaine 125 mg was injected with intermittent aspiration. Within 30 seconds the patient had a generalized tonic-clonic seizure which lasted about 30 seconds and self-terminated. She remained car-diovascularly stable and made an uneventful recovery. 

Lidocaine hydrochloride is a local anesthetic/vasopressor preparation. Lidocaine stabilizes neuronal membranes by inhibiting the ionic fluxes required for the initiation and conduction of impulses, thereby effecting local anesthetic action. Epinephrine stimulates both alpha and beta receptors within sympathetic nervous system relaxes smooth muscle of bronchi and iris and is an antagonist of histamine. They are indicated for production of local or regional anesthesia by infiltration techniques such as percutaneous injection, by peripheral nerve block techniques such as brachial plexus and intercostals, and by central neural techniques such as lumbar and caudal epidural blocks. 

Injection of a local anesthetic into or around individual peripheral nerves or nerve plexuses produces even greater areas of anesthesia than do the techniques described above. Blockade of mixed peripheral nerves and nerve plexuses also usually anesthetizes somatic motor nerves, producing skeletal muscle relaxation, which is essential for some surgical procedures. The areas of sensory and motor block usually start several centimeters distal to the site of injection. Brachial plexus blocks are particularly useful for procedures on the upper extremity and shoulder. Intercostal nerve blocks are effective for anesthesia and relaxation of the anterior abdominal wall. Cervical plexus block is appropriate for surgery of the neck. Sciatic and femoral nerve blocks are useful for surgery distal to the knee. Other useful nerve blocks prior to surgical procedures include blocks of individual nerves at the wrist and at the ankle, blocks of individual nerves such as the median or ulnar at the elbow, and blocks of sensory cranial nerves. 

Nervous system Brachial plexus paby has been attributed to tumescent anesthesia [45 ]. 

One of the first uses of local anesthetics (LA) for anesthesia was in the late nineteenth century with William Halsted reporting a mandibular block and brachial plexus block using cocaine [37,38]. The chemical structure of local anesthetics in clinical use consists of an aromatic (lipophilic) benzene ring linked to an amino group (hydrophflic) via either an ester or an amide intermediate chain. The intermediate link classifies the local anesthetic as either an ester (procaine, chloroprocaine, tetracaine, and cocaine) or an amide (lidocaine, prilocaine, mepivacaine, bupi-vacaine, etidocaine, and ropivacaine). 

Arcas-Bellas JJ, Cassinello F, Cercos B, del Valle M, Leal V, Alvarez-Rementeria R. Delayed quadriparesis after an interscalene brachial plexus block and general anesthesia a differential diagnosis. Anesth Analg 2009 109(4) 1341-3. 

Local anesthesia and regional blocks, commonly used in vascular access surgery, may affect vein diameter and fistula blood flow rates, which are important predictors of fistula failure. Regional block anesthesia (brachial plexus block) is associated with vasodilation in both the cephalic and basilic veins and with increased fistula blood flow. 

Yang WT, Chui PT, Metreweli C (1998) Anatomy of the normal brachial plexus revealed by sonography and the role of sonographic guidance in anesthesia of the brachial plexus. AJR Am J Roentgenol 171 1631-1636 Yao L, Metha U (2003) Infraspinatus muscle atrophy implications Radiology 226 161-164... 

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