Understanding Anesthesiology - The Global Regional Anesthesia ...

cles (Figure 19).They then travel under the clavicle and
enter the axilla as three distinct cords. As they exit the
axilla, the plexus divides one final time to form the axillary,
radial, median, ulnar and musculocutaneous
nerves. The brachial plexus block provides anesthesia
for virtually any type of upper extremity surgery.
The brachial plexus can be blocked at one of its three
most superficial locations: interscalene, supraclavicular
Figure 18 Sensory innervation of upper limb
or axillary. Sterile technique is used at all times and correct
needle placement is ensured through the use of either
ultrasound or nerve stimulator. A relatively large
volume of LA is injected (30-40 ml). Up to 45 minutesmay
be required until adequate anesthesia is achieved,
depending on how close to the nerve bundle the local
anesthetic is deposited. If several hours of anesthesia
are required, then bupivacaine or ropivacaine is used.
Figure 19 Brachial plexus: anatomical depiction
Public domain image derived from Gray’s Anatomy, retrieved
from Wikimedia Commons.
Gray’s Anatomy image in public domain, retrieved from Wikimedia
Commons.
58