Upper Extremity Blocks

Abstract

Upper extremity blocks are becoming increasingly popular for Orthopedic and Ambulatory Anesthesia. Since pain originates from the periosteum, knowledge of osseous innervation is important for a successful block. Choosing the correct approach will allow one to successfully operate on the shoulder, clavicle and proximal humerus, or the distal humerus, forearm and hand. The risks associated with the blocks help determine the approach used. The interscalene and supraclavicular approaches have a high risk of diaphragmatic paralysis. The infraclavicular approach has a potential for vascular puncture and difficulty with external compression due to the depth of the vessel, and is usually contraindicated in patients with same side cardiac pacemakers. Axillary blocks should be avoided in patients who cannot abduct their arm.

Keywords: Axillary block, Brachial plexus, Interscalene block, Infraclavicular block, Neurostimulation, Radial nerve block, Supraclavicular block, Ulnar nerve block, Ultrasound guidance.