Upper Extremity Blocks
Pp. 23-46 (24)
De Q.H. Tran
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.
Axillary block, Brachial plexus, Interscalene block, Infraclavicular
block, Neurostimulation, Radial nerve block, Supraclavicular block, Ulnar nerve
block, Ultrasound guidance.
McGill University, Montreal, Canada.