Ultrasound Guided Brachial Plexus Block

The brachial plexus innervates nearly the entire upper extremity, with minor supplements from the cervical plexus to the shoulder and thoracic nerves T2 to the medial side of the arm. The efficacy and effectiveness of regional anesthesia in upper extremity procedures have reached a golden stage after the introduction and wide-adoption of ultrasound in clinical practice. Performing an upper extremity block under real time ultrasound guidance with precision during injection results in faster block onset, higher rates of block success (Neal et al., Reg Anesth Pain Med 35:S1-S9, 2010) and lower risk of complications such as intravascular injection and local anesthetic systemic toxicity (Barrington and Kluger, Reg Anesth Pain Med 38:289-299, 2013) as compared to historical landmark techniques or via nerve stimulation. Ultrasound guided brachial plexus blockade is an intermediate level technique that offers many benefits: (a) Excellent analgesia, resulting in opioid reduction even opioid sparing; (b) With the capacity to provide surgical anesthesia thus with general anesthesia sparing potential. To successfully perform a regional block, it is important to understand the anatomy and sono-anatomy of the target nerve or plexus.