Upper extremity nerve blocks: Techniques
- Christina L Jeng, MD
Christina L Jeng, MD
- Assistant Professor of Anesthesiology and Orthopaedics
- Icahn School of Medicine at Mount Sinai
- Meg A Rosenblatt, MD
Meg A Rosenblatt, MD
- Professor of Anesthesiology and Orthopaedics
- Icahn School of Medicine at Mount Sinai
Peripheral nerve blocks of the upper extremity are used for operative anesthesia and/or postoperative analgesia for a variety of upper extremity surgeries.
This topic will discuss the innervation of the upper extremity, techniques and drugs used for upper extremity nerve blocks, and complications specific to these blocks. Indications, contraindications, comparison of techniques relevant to all peripheral nerve blocks, equipment, and complications common to all nerve blocks are discussed separately. (See "Overview of peripheral nerve blocks".)
INNERVATION: UPPER EXTREMITY
The brachial plexus is formed by the ventral rami of the lower cervical and upper thoracic nerve roots (figure 1 and figure 2). It supplies cutaneous and muscular innervation to the upper extremity, with the exception of the trapezius muscle, the cape of the shoulder, and a small area of skin near the axilla (figure 3). The cervical plexus supplies cutaneous innervation above the clavicle, the shoulder tip, and the first two anterior intercostal spaces through the superficial cervical plexus and the supraclavicular nerves (C3 and C4).
The nerve roots emerge in the neck from the transverse processes of the cervical vertebrae posterior to the vertebral artery. The trunks of the brachial plexus (superior [C5,C6], middle [C7], inferior [C8,T1]) pass between the anterior and middle scalene muscles. At this point, the phrenic nerve is located anterior to the anterior scalene muscle. The trunks divide into the anterior and posterior divisions, corresponding to the ventral and dorsal upper extremities, respectively (figure 2).
Passing over the first rib and continuing beneath the clavicle, the cords of the brachial plexus form and are named according to their position relative to the axillary artery (ie, lateral, posterior, and medial). The cords give rise to the five major nerves of the upper extremity:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- INNERVATION: UPPER EXTREMITY
- BRACHIAL PLEXUS BLOCKS
- Interscalene block
- - Positioning
- - Ultrasound-guided interscalene block
- - Nerve stimulator-guided interscalene block
- - Perineural catheter interscalene block
- - Side effects and complications of interscalene block
- Supraclavicular block
- - Positioning
- - Ultrasound-guided supraclavicular block
- - Nerve stimulator-guided supraclavicular block
- - Perineural catheter supraclavicular block
- - Side effects and complications of supraclavicular block
- Infraclavicular block
- - Positioning
- - Ultrasound-guided infraclavicular block
- - Nerve stimulator-guided infraclavicular block
- - Perineural catheter infraclavicular block
- - Side effects and complications of infraclavicular block
- Axillary block
- - Positioning
- - Ultrasound-guided axillary block
- - Transarterial axillary block
- - Nerve stimulator-guided axillary block
- - Side effects and complications of axillary block
- INTERCOSTOBRACHIAL NERVE BLOCK
- WRIST BLOCKS
- Radial nerve block
- Median nerve block
- Ulnar nerve block
- DIGITAL NERVE BLOCK (FINGER)
- DRUG CHOICES
- INTRAVENOUS REGIONAL ANESTHESIA (BIER BLOCK)
- IV regional anesthesia technique
- Side effects and complications of IV regional
- SUMMARY AND RECOMMENDATIONS