Regional Anesthesia for Upper Limb Surgery: A Narrative Review

Abstract

Regional anesthesia is an expanding subspecialty and is gaining increasing popularity due to its significant benefits over general anesthesia if appropriately accomplished, which includes superior intraoperative pain control, attenuation of the surgical stress response, minimal systemic impairment, lower incidence of postoperative nausea and vomiting, excellent localized postoperative analgesia, and decreased hospital cost and stay. Needle conduction guide toward the targets always has a great importance. The most commonly used local anesthetics include lidocaine, ropivacaine, bupivacaine, and mepivacaine. The type of local anesthetic, the concentration, the volume administered, and the location of the block will affect the onset, duration and depth /type of block. Due to ineffectivity of neuraxial block in upper limbs, upper extremity blocks may be considered as the sole substitute or supersede method of anesthesia for upper limb surgeries.

Regional anesthesia for geriatric population

“…RA has been found to be more effective in providing pain management in upper limb surgery than in GA.[ 5 ] Furthermore, it has been observed to reduce the incidence of postoperative cognitive dysfunction and mitigate the probability of adverse effects such as deep vein thrombosis, pneumonia, and pulmonary embolism. [ 6 7 ] PN blocks are frequently utilized in surgical procedures involving the upper extremities, particularly in patients suffering from perioperative pain in the upper extremity. [ 8 ] To perform RA of the upper extremity, the anesthesiologist must be well-versed in the anatomy of the brachial plexus (BP) to optimize block selection and placement.…”