Chapter

Upper limb blocks

David Coventry

in Principles and Practice of Regional Anaesthesia

Fourth edition

Published on behalf of Oxford University Press

Published in print November 2012 | ISBN: 9780199586691
Published online November 2012 | e-ISBN: 9780191755507 | DOI: http://dx.doi.org/10.1093/med/9780199586691.003.0017

Series: Oxford Textbooks in Anaesthesia

Upper limb blocks

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Nerve block techniques can play a major role in the management of procedures on the upper limb, providing both anaesthesia for operative surgery and analgesia thereafter. Brachial plexus block can greatly simplify the anaesthetic management of patients with significant medical co-morbidity, particularly those with respiratory or cardiovascular disease, obesity, diabetes, altered conscious level, or a compromised or difficult airway. In addition, prolonged infusion techniques for more major surgery may facilitate earlier limb mobilization and have the potential to reduce hospital stay and improve functional outcome. The pattern of block is partly determined by the approach used, and it is important to relate the surgical requirements to the features of the specific method because each has its limitations in regard to the extent of block and the risk of side effects (Table 17.1). Local infiltration or distal individual nerve blocks can also be used to supplement brachial plexus techniques or to produce a restricted field of block according to surgical need. This would include local anaesthesia for brief surgical procedures, those not requiring a proximal arm tourniquet, and those where additional general anaesthesia is employed for other indications such as iliac crest bone graft harvesting. In recent years, the development of ultrasound-guided approaches has stimulated widespread interest and reappraisal of many of these techniques, leading to hopes of more successful blocks and fewer side effects (Chapter 10). Although there is a lack of well-controlled, large-scale studies comparing rates of block efficacy and complications when ultrasound or peripheral nerve stimulation is used, there is a growing volume of work in the literature to support the former’s routine use for upper limb blocks (McCartney et al. 2010).

Chapter.  10748 words.  Illustrated.

Subjects: Anaesthetics ; Clinical Skills ; Anatomy

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