Upper extremity nerve block: how can benefit, duration, and safety be improved? An update

Abstract

Upper extremity blocks are useful as both sole anaesthesia and/or a supplement to general anaesthesia and they further provide effective postoperative analgesia, reducing the need for opioid analgesics. There is without doubt a renewed interest among anaesthesiologists in the interscalene, supraclavicular, infraclavicular, and axillary plexus blocks with the increasing use of ultrasound guidance. The ultrasound-guided technique visualising the needle tip and solution injected reduces the risk of side effects, accidental intravascular injection, and possibly also trauma to surrounding tissues. The ultrasound technique has also reduced the volume needed in order to gain effective block. Still, single-shot plexus block, although it produces effective anaesthesia, has a limited duration of postoperative analgesia and a number of adjuncts have been tested in order to prolong analgesia duration. The addition of steroids, midazolam, clonidine, dexmedetomidine, and buprenorphine has been studied, all being off-label when administered by perineural injection, and the potential neurotoxicity needs further study. The use of perineural catheters is an effective option to improve and prolong the postoperative analgesic effect. Upper extremity plexus blocks have an obvious place as a sole anaesthetic technique or as a powerful complement to general anaesthesia, reducing the need for analgesics and hypnotics intraoperatively, and provide effective early postoperative pain relief. Continuous perineural infusion is an effective option to prolong the effects and improve postoperative quality.

Minimally invasive pain management in chronic musculoskeletal pain: A Community service at Blahkiuh I Health Center

“…[12][13][14] In recent years various medical interventions have been successfully carried out. [15][16][17][18][19][20][21][22] Medical intervention continues to be developed in order to effectively eliminate pain with minimal risks. Several medical intervention techniques with invasive procedures for pain have also been performed, such as hydrodisectomy with ultrasound guidance.…”

Physiological Responses and Gene Expression in Ultrasound-Guided Supraclavicular Brachial Plexus Block: a Comparative Study

“…Moreover, it reduces the duration of hospitalization and costs, and provides complete muscle relaxation [1, 2]. The ultrasound-guided technique requires a lower anesthetic volume to provide an efficient block and decreases the risk associated with intravascular injections and trauma to the surrounding tissues [3]. …”

“…Bupivacaine alone is now less frequently used as a local anesthetic because of its short duration of action [3]. Several adjuvants have been co-administered with bupivacaine, but the results have been either unconvincing or associated with untoward complications [4].…”

Ultrasound and nerve stimulator guided peripheral nerve blocks of the upper and lower limbs

“…P eriferni nervni blokovi danas se koriste u hirurgiji gornjih i donjih ekstremiteta ne samo u cilju obezbeđivanja anestezije za hirurške procedure nego i kao dijagnostički, prognostički, preemptivni, a u poslednje vreme sve više i kao deo multimodalne analgezije 1 . Tome su doprinele brojne prednosti, uključujući pre svega minimalnu pripremu pacijenta, kardiorespiratornu stabilnost, koja je obezbeđena tokom hirurške intervencije, i smanjenje postoperativne mučnine i povraćanja u odnosu na centralnu sprovodnu anesteziju.…”

“…Uvođenje nervnog stimulatora, a u poslednjih deset godina i ultrazvuka, doprinelo je promenama u svakodnevnoj praksi, omogućivši značajno širu primenu perifernih nervnih blokova, uz danas najviši stepen uspešnosti, ali i sigurnosti za pacijenta 1 . Nervnim stimulatorom se generiše električni impuls niskog inteziteta (do 5 mA), kratkog trajanja (0,05-1 ms) i frekvence (1-2 Hz), a kojim se dobija motorni ili senzorni odgovor nerva.…”