Brachial plexus block

A supraclavicular brachial plexus block was performed which resulted in unilateral sensory and motor blockade of the thoracic and abdominal walls. General anaesthesia was therefore used and postoperatively it was noticed that analgesia of the upper limb had developed. It is likely that the blockade resulted from an intrapleural injection of local anaesthetic.     

Brachial plexus. Anesthesia and analgesia

This review explains the different approaches to the brachial plexus (posterior cervical, interscalene, supra- and infraclavicular, and axillary) and their advantages and disadvantages (indications, contraindications, and complications) for surgery and postoperative or chronic pain management. One of the focussed areas of this review is the use of continuous catheter techniques. Information about the most commonly used local anesthetics as well as adjuncts suggested in the literature is summarized. As essential components for the success of those techniques, organizational and documentation requirements are described. In summary, regional techniques for single shot or continuous block of the brachial plexus are an efficient and safe way of providing anesthesia and analgesia for surgery or pain in the region of the shoulder, arm, or hand.     

Brachial plexus injury following brachial plexus block

A patient developed paralysis over the left upper limb 2 days after an otherwise uneventful supraclavicular brachial plexus block. Symptoms continued for 8 weeks after the block. The various possible causes for this complication are discussed. Although brachial plexus injury following the block is rare, some recommendations are made to reduce the incidence of this complication.     

Brachial plexus postoperative analgesia at home

Advances in anesthetic and surgical techniques, along with escalating health care costs, have resulted in an ever-increasing number of surgical procedures being performed on a day-case basis worldwide. Since the proportion of surgery done on an outpatient basis is increasing, and since early discharge and patient satisfaction are important goals, pain management is receiving greater attention.¹ Rapid recovery after the use of new, short-acting anesthetic agents has led to the concept of fasttracking and by-passing the postanesthetic care unit (PACU).² However, the success of fast-tracking will depend to a considerable extent on effective postoperative pain management routines with simple methods. The potential cost saving of outpatients surgery may be negated by unanticipated hospital admission for poorly treated pain. © 2003 Elsevier Inc. All rights reserved.     

Brachial plexus block with bupivacaine: effects of added alpha-adrenergic agonists: comparison between clonidine and epinephrine

The effects of clonidine and epinephrine, administered into the brachial plexus sheath, were evaluated in 60 patients who underwent surgery of the upper limb. All patients received 40 to 50 ml of 0.25% bupivacaine, injected into the brachial plexus sheath, using the supraclavicular technique. The patients were randomly allocated to two groups so that 30 patients received 150 micrograms clonidine hydrochloride (Group I), and 30 received 200 micrograms epinephrine (Group II). The quality and the duration of analgesia were assessed as well as the possible side-effects. The block produced with the addition of clonidine was longer (994.2 +/- 34.2 vs 728.3 +/- 35.8 min) and superior to that with epinephrine (P less than 0.001). No major side-effects were recorded. We conclude that the injection of clonidine into the brachial plexus sheath is an attractive alternative to epinephrine to prolong the duration of analgesia following upper limb surgery under conduction anaesthesia.     

罗比卡因与布比卡因用于连续臂丛神经阻滞术后镇痛的比较

目的观察0.125%罗比卡因与0.125%布比卡因应用于上肢连续臂丛阻滞患者术后自控镇痛的可行性和有效性。方法45例拟行上肢择期手术的患者随机分为罗比卡因组(R组)、布比卡因组(B组)和对照组(N组),每组15例。术前均予肌间沟径路或腋路臂丛阻滞以及臂丛神经鞘内置管。术后R组与B组使用便携式患者自控镇痛泵,泵内液体分别为0.125%的罗比卡因和0.125%的布比卡因,N组为对照组,观察24h。记录3组患者的疼痛视觉模拟评分和镇痛药使用情况,记录R组与B组患者的运动阻滞、麻木感、局麻药用量、满意度、镇痛技术问题和并发症。结果R组与B组两组在术后各个时间点的疼痛评分均较低,组间差异无统计学意义(P>0.05)。N组疼痛评分在术后0h、3h时与R组和B组比较差异无统计学意义(P>0.05);在术后6h、12h、18h、24h均较高,与前两组间相比差异有统计学意义(P<0.05)。R组与B组两组镇痛满意度较高,组间差异无统计学意义(P>0.05),运动阻滞、麻木感、补充用药、局麻药用量差异无统计学意义(P>0.05);技术问题与并发症两组发生率均低。结论0.125%罗比卡因与0.125%布比卡因均可有效地用于上肢术后的连续臂丛阻滞患者自控镇痛,并且效果相似。