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Upper Extremity Blocks
Rafael Vazquez, MD; Colin J. McCarthy, MB, BCh, BAO, MRCSI, FFR (RCSI); Daniel Pak, MD
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KEY FACTS

  • Preprocedure

    • Procedure

      • Post Procedure

        • Outcomes

          TERMINOLOGY

          • Definitions

            • Peripheral neuropathy: Damage or injury to nerves of peripheral nervous system
            • Mononeuropathy: Disorder of single nerve, often characterized by sensory or motor deficits in distribution of affected nerve
              • Etiologies include 
                • Trauma
                • Overuse injury
                • Autoimmune disorders
            • Polyneuropathy: Disorder of multiple peripheral nerves, characterized by diffuse sensory and motor deficits of affected extremities; can be acquired or hereditary
              • Acquired etiologies: Diabetes mellitus, alcohol abuse, toxins (i.e., chemotherapy), poor nutrition (i.e., vitamin B12 deficiency)
              • Hereditary etiologies: Charcot-Marie-Tooth disease, autoimmune disease

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Equipment Preparation

                      • Procedure Steps

                        • Findings and Reporting

                          • Alternative Procedures/Therapies

                            POST PROCEDURE

                            • Expected Outcome

                              • Things To Do

                                • Things To Avoid

                                  OUTCOMES

                                  • Complications

                                    Selected References

                                    1. Helander EM et al: Regional nerve blocks-best practice strategies for reduction in complications and comprehensive review. Curr Pain Headache Rep. 23(6):43, 2019
                                    2. Soberón JR Jr et al: Distal peripheral nerve blocks in the forearm as an alternative to proximal brachial plexus blockade in patients undergoing hand surgery: a prospective and randomized pilot study. J Hand Surg Am. 41(10):969-77, 2016
                                    3. Sohoni A et al: Forearm ultrasound-guided nerve blocks vs landmark-based wrist blocks for hand anesthesia in healthy volunteers. Am J Emerg Med. 34(4):730-4, 2016
                                    4. Strakowski JA: Ultrasound-guided peripheral nerve procedures. Phys Med Rehabil Clin N Am. 27(3):687-715, 2016
                                    5. Brull R et al: Pathophysiology and etiology of nerve injury following peripheral nerve blockade. Reg Anesth Pain Med. 40(5):479-90, 2015
                                    6. Kirksey MA et al: Local anesthetic peripheral nerve block adjuvants for prolongation of analgesia: a systematic qualitative review. PLoS One. 10(9):e0137312, 2015
                                    7. Meco BC et al: Can we gain an advantage by combining distal median, radial and ulnar nerve blocks with supraclavicular block? A randomized controlled study. J Anesth. 29(2):217-22, 2015
                                    8. Sehmbi H et al: Ultrasound guided distal peripheral nerve block of the upper limb: a technical review. J Anaesthesiol Clin Pharmacol. 31(3):296-307, 2015
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Preprocedure

                                      • Procedure

                                        • Post Procedure

                                          • Outcomes

                                            TERMINOLOGY

                                            • Definitions

                                              • Peripheral neuropathy: Damage or injury to nerves of peripheral nervous system
                                              • Mononeuropathy: Disorder of single nerve, often characterized by sensory or motor deficits in distribution of affected nerve
                                                • Etiologies include 
                                                  • Trauma
                                                  • Overuse injury
                                                  • Autoimmune disorders
                                              • Polyneuropathy: Disorder of multiple peripheral nerves, characterized by diffuse sensory and motor deficits of affected extremities; can be acquired or hereditary
                                                • Acquired etiologies: Diabetes mellitus, alcohol abuse, toxins (i.e., chemotherapy), poor nutrition (i.e., vitamin B12 deficiency)
                                                • Hereditary etiologies: Charcot-Marie-Tooth disease, autoimmune disease

                                            PREPROCEDURE

                                            • Indications

                                              • Contraindications

                                                • Preprocedure Imaging

                                                  • Getting Started

                                                    PROCEDURE

                                                    • Patient Position/Location

                                                      • Equipment Preparation

                                                        • Procedure Steps

                                                          • Findings and Reporting

                                                            • Alternative Procedures/Therapies

                                                              POST PROCEDURE

                                                              • Expected Outcome

                                                                • Things To Do

                                                                  • Things To Avoid

                                                                    OUTCOMES

                                                                    • Complications

                                                                      Selected References

                                                                      1. Helander EM et al: Regional nerve blocks-best practice strategies for reduction in complications and comprehensive review. Curr Pain Headache Rep. 23(6):43, 2019
                                                                      2. Soberón JR Jr et al: Distal peripheral nerve blocks in the forearm as an alternative to proximal brachial plexus blockade in patients undergoing hand surgery: a prospective and randomized pilot study. J Hand Surg Am. 41(10):969-77, 2016
                                                                      3. Sohoni A et al: Forearm ultrasound-guided nerve blocks vs landmark-based wrist blocks for hand anesthesia in healthy volunteers. Am J Emerg Med. 34(4):730-4, 2016
                                                                      4. Strakowski JA: Ultrasound-guided peripheral nerve procedures. Phys Med Rehabil Clin N Am. 27(3):687-715, 2016
                                                                      5. Brull R et al: Pathophysiology and etiology of nerve injury following peripheral nerve blockade. Reg Anesth Pain Med. 40(5):479-90, 2015
                                                                      6. Kirksey MA et al: Local anesthetic peripheral nerve block adjuvants for prolongation of analgesia: a systematic qualitative review. PLoS One. 10(9):e0137312, 2015
                                                                      7. Meco BC et al: Can we gain an advantage by combining distal median, radial and ulnar nerve blocks with supraclavicular block? A randomized controlled study. J Anesth. 29(2):217-22, 2015
                                                                      8. Sehmbi H et al: Ultrasound guided distal peripheral nerve block of the upper limb: a technical review. J Anaesthesiol Clin Pharmacol. 31(3):296-307, 2015