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Upper extremity nerve blocks: Techniques

Authors
Christina L Jeng, MD
Meg A Rosenblatt, MD
Section Editor
Robert Maniker, MD
Deputy Editor
Marianna Crowley, MD

INTRODUCTION

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 superficial cervical plexus supplies cutaneous innervation over the clavicle, the cape of the shoulder, and the first two anterior intercostal spaces (supraclavicular nerves, C3 and C4).

The nerve roots emerge in the neck adjacent to the transverse processes of the cervical vertebrae and posterior to the vertebral artery. The nerve roots continue as the trunks of the brachial plexus (superior [C5,C6], middle [C7], inferior [C8,T1]) and pass between the anterior and middle scalene muscles. At this point, the phrenic nerve is located anterior to the anterior scalene muscle. Each trunk divides into an anterior and posterior division, which in turn correspond to the ventral and dorsal upper extremities, respectively (figure 2).

All three trunks pass over the first rib and continue deep to the clavicle. The cords of the brachial plexus form from the trunks just distal to the first rib and are named according to their position relative to the axillary artery (lateral, posterior, and medial). The cords give rise to the five major nerves of the upper extremity:

                                    
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Literature review current through: Oct 2017. | This topic last updated: Oct 31, 2017.
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