introduction

Brachial plexus anesthesia is a regional anesthesia procedure under which operations on the arm are possible. The procedure is relatively simple to perform and has few complications. In addition to being used during operations, brachial plexus anesthesia can also be used for chronic pain.

Read more on the topic: Conduction anesthesia

Anatomy of the brachial plexus

Of the Brachial plexus is a complex one Nerve plexus, which is composed of the spinal nerves C5 to Th1 and above all Arms and hands, but also the Shoulder region supplied with nerves. After exiting the spinal canal, it runs between two muscles on the neck, the scalene anterior and medius muscles, which are known as the "Scalene gap" form. In the further course it then runs under the collarbone towards the arm. On its way, the brachial plexus is accompanied by blood vessels. This complete strand of nerves and blood vessels is enveloped by connective tissue plates and divided into different compartments.

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Performing anesthesia

At the brachial plexus anesthesia is done with a hypodermic needle local anesthetic administered into one of the compartments and then distributed along the nerve plexus. The anesthesia depends on which nerves or which parts of the arm are to be anesthetized On different parts injected.

A nerve stimulator and / or an ultrasound device are definitely helpful when looking for the plexus. The nerve stimulator is coupled to the injection needle and indicates the right place for anesthesia by twitching the muscles supplied by the nerve with electrical impulses. With the help of the ultrasound device you can visualize the nerves themselves, which look something like a cloud or cotton wool. Or you orientate yourself on lead structures such as blood vessels, which run similarly.

indication

The local anesthetic that is injected near the brachial plexus inhibits the transmission of the action potential along the nerve by acting on the respective ion channels. This will provide information such as S.pain or pressure not passed on.

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The indication for a nerve block is mainly in operational areato get at a Intervention on the arm to avoid pain if possible. This can be used during the subsequent anesthesia and after the operation Saved painkillers so that, as a result, the patient develops fewer side effects from the pain medication and generally experiences less pain.
An operation on the arm can also be done this way without anesthesia take place, since the arm is numbed in every respect. This procedure can also be used at elderly or seriously ill people performed in which general anesthesia is not possible.
For example, the brachial plexus can be used during anesthesia Adjusting a dislocated shoulder (Shoulder dislocation) are used so that the pain can be endured and the straightening can take place while conscious. Another operation in which such a method can be used is, for example, a distal radius fracture.

In addition, a nerve block in the brachial plexus can alleviate the symptoms cchronic pain to reduce.

Generally the local anesthetic can administered once or by means of an indwelling catheter made of plastic, which can be fixed near the plexus for a certain time, sprayed several times as required become.

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Accesses

Depending on the occasion, a specific place of the brachial plexus was chosen for the injection of the anesthetic, since numerous, quite complex switchings of the individual nerves take place in the nerve plexus and thus the different qualities can be found in different places. One distinguishes different approaches the brachial plexus anesthesia.

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At the interscalene access the brachial plexus is blocked relatively at the beginning after passing the scalenus gap, so that especially the Region of shoulder and upper arm numbed becomes. This approach is suitable for reducing a dislocated shoulder.

Of the supraclavicular block should the numb whole arm and is placed above the collarbone near the subclavian artery and the first rib. This method is used less often because of the risk of a Pneumothorax is too big.

A good alternative to numbing the whole arm is vertical infraclavicular blockwho has a high success rate. However, it does not cover the shoulder region. The injection site lies below the collarbone and is intended to hit the compartment in which the brachial plexus is accompanied by the axillary artery and vein. This box should also be used for the so-called axillary block anesthesia, but access is through the armpit.

Complications

Generally the brachial plexus is an anesthetic safe and uncomplicated procedure. Unwanted symptoms would be caused by a Damage to the nerve evoked with the injection needle Sensory disturbances after anesthesia, as well as the formation of a Bruise by puncturing one of the surrounding blood vessels.
A more serious complication is puncture of the pleura, which is a Pneumothorax would evoke. It can also become a allergic reaction on the drug or materials used.

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