Text Book Reading II

PHERIPHERAL NERVE BLOCKADE

Rudy Humisar Siahaan

Pembimbing : dr. Aidyl Fitrisyah, SpAn
DEPARTEMEN ANESTESIOLOGI DAN TERAPI INTENSIF
FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA
RSUP Dr. MOHAMMAD HOESIN PALEMBANG
2020
Chapter 36. Peripheral Nerve Blockade
Eighth Edition
Copyright © 2017 Wolters Kluwer
PLEXUS BRACHIALIS
 BRACHIAL PLEXUS BLOCK
1. INTERSCALENE BLOCK
2. SUPRACLAVICULAR BLOCK
3. INFRACLAVICULAR BLOCK
4. AXILLARY BLOCK
5. TERMINAL
A. RADIAN BLOCK
B. MEDIAN BLOCK
C. ULNAR BLOCK
 INTERSCALENE BLOCK
CLAVICLE, SHOULDER, ARM, FOREARM
LANDMARK STERNOCLEIDOMASTOIDEUS
Patient head turned to the contralateral side about
30 – 45 degrees.
Place machine on opposite side of patient.
Start in the supraclavicular fossa with your
transducer placed transversely.
Find the subclavian artery and brachial plexus next
to it.
 INTERSCALENE BLOCK
• Use color Doppler to find and avoid the
transverse cervical artery.
• Approach in-plane view (ie. visualizing the
entire needle length) lateral to medial in the
interscalene groove.
• Inject 20 cc of anesthetic near C5-7 with the
anesthestic appearing as hypoechoic fluid
extent of spread of anesthetic.
 SUPRACLAVICULAR BLOCK
• Indications: Arm, elbow, forearm, hand surgery;
anesthesia for shoulder surgery is also possible
• Transducer position: Transverse on the neck,
superior to the clavicle at the midpoint
• Goal: Local anesthetic spread around the
brachial plexus, posterior and superficial to the
subclavian artery
• Local anesthetic: 20–25 mL
 BLOCK OF THE ELBOW
• Indications: Hand and wrist surgery
• Transducer position: Transverse on the elbow
• Goal: Injection of local anesthetic within the
vicinity of individual nerves (radial, median, and
ulnar)
• Local anesthetic: 4–5 mL per nerve
• When in doubt, nerve stimulation (0.5–1.0 mA)
can be used to confirm the localization of the
correct nerve.