الفهرس 
Anatomy of the Brachial PlexusOnly 14 pages are availabe for public view
 |  | from | 139 |  |  |
| | | from | 139 | | |
Abstract
Regional anesthesia for upper limb can be established through different approaches. These approaches include supraclavicular, infraclavicular, interscalene, axillary, local intravenous and wrist block approach.
The brachial plexus is formed by the ventral primary rami of C5 to C8 and T1 spinal nerves. It supplies all the motor and most of the sensory innervation of the upper limb. This nerves are blocked for surgery and for postoperative analgesia and chronic pain management.
Supraclavicular approach: the supraclvicular approach blocks the brachial plexus in the area where it is most compact thus it provides the most rapid onset time and the highest success rate to anaesthetize all of the branches of the brachial plexus than any other approach. It may be performed with the arm in any position and it can provide anesthesia for forearm, hand and even shoulder surgery.
The infraclavicular approach has the advantage that it could anaesthetize the five terminal nerves of the brachial plexus. It is used for forearm, arm, and hand surgery.
In the interscalene approach the most important factor in interscalene brachial plexus is to correctly identify the groove between the anterior and middle scalene muscles. Interscalene block is the block of choice for shoulder surgery as it blocks the upper roots of brachial plexus and lower roots of cervical plexus.
Axillary block characterized by being easy, safe and its ability for anesthesia of foream and hand so it is the ideal method for ambulatory anesthesia.
Local intravenous approach used for short surgeries in the forearm or wrist and provide good postoperative analgesia.
Wrist block used for surgery in the hand or in the fingers and it block mainly radial, ulnar and median nerves in the hand
It is very helpful to anaesthesiologists because of its simplicity and low incidence of complications and its utility for hand and forearm surgery. This makes it ideal for outpatient surgery.
Eliciting paraesthesia and the use of nerve stimulator are useful tools that increase the success rate of brachial plexus block techniques. Now the use of ultrasound guidance in all brachial plexus block techniques has markedly increased the success rate of the blocks and allowed the use of smaller volume of local anaesthetics. The use of continuous catheter techniques has allowed better management of postoperative pain, chronic pain of upper limb, and cancer pain.
Local anaesthetic drugs of moderate duration as lidocaine, mepivacaine, and prilocaine are used in shorter procedures while drugs such as ropivacaine, and bupivacaine are used for longer operations and postoperative pain management. Additives to local anaesthetics such as epinephrine, clonidine, provide better analgesia and longer duration of action.
Finally, full monitoring of vital data should be done during the surgical procedure and to have at hand all facilities for resuscitation if cardiotoxicity or neurotoxicity from local anaesthetic occur or complications due to the procedure itself.