Brachial Plexus Nerve Block

Brachial Plexus Nerve Block

Brachial plexus block

  • This is the second most commonly practised block after central neuraxial block (spinal & epidural anaesthesia). 
  • Brachial plexus block is used for upper limb surgeries.
  • Brachial plexus can be blocked by 4 approaches : –

1.  Interscalene approach

  • Brachial plexus is blocked between anterior and middle scalene. 
  • This approach is not used routinely due to close proximity of vital structures. 
  • Ulnar nerve is usually spared by this approach because injection is given in close proximity of upper nerve roots and inferior nerve roots (C8-T 1) may be spared.
  • This technique provides excellent anaesthesia and analgesia for shoulder and upper arm procedures. (in contrast to other three approaches which do not provide adequate shoulder anaesthesia).
  • Complications include Horner syndrome (due to stellate ganglion block), phrenic nerve block, intravascular injection into carotids and epidural or intrathecal injections.

2.  Supraclavicular approach   

  • This is the most commonly used approach.
  • It involves the injection of local anaesthetic in close proximity to the trunks of the brachial plexus by inserting the needle lateral to subclavian vessels. 
  • The supraclavicular block is performed where the brachial plexus is most compact, consequently, it produces reliable and rapid onset anaesthesia and is particularly useful in a fast paced ambulatory surgery centre.
  • Pneumothorax is the most common complication. Other complications include phrenic nerve block, intravascular injection in subclavian artery or vein, Horner syndrome, hematoma formation.

3. Infra-clavicular approach

  • Infraclavicular block involves the injection of local anaesthetic in close proximity of cords of the brachial plexus. 
  • The axillary nerve may be spared as this nerve exits the brachial plexus sheath proximal to the level of infraclavicular block.

4. Axillary approach

  • Axillary block involves the injection of local anaesthetic in close proximity of terminal branches of the brachial plexus.
  • The major disadvantage of this approach is that mucocutaneous and intercostobrachial nerves are spared.
  • So arm surgery cannot be performed. In contrast to interscalene approach, most intense block occur in (C7-T1) ulnar dermatomes and least in C5-C6 dermatomes.
Exam Question
  • Most commonly used approach of brachial plexus block is Supraclavicular.
  • Exposure of left subclavian artery by supraclavicular approach does not require cutting of Scalenus medius.
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