What Is a Brachial Plexus Block?

There is inflammation or infection at the puncture site.

Brachial plexus block anesthesia

Anesthesia by injecting a local anesthetic around the brachial plexus nerve trunk to cause nerve conduction block in the area dominated by it is called brachial plexus block anesthesia. It is one of the commonly used anesthesia methods in clinical practice. Suitable for various operations on hands, forearms, upper arms and shoulders.

Contraindications of Brachial Plexus Block Anesthesia

There is inflammation or infection at the puncture site.

Brachial plexus block anesthesia operation method

According to the puncture site, it can be divided into the following three methods:

Intermuscular groove method: the preferred method of anesthesia for shoulder and upper arm surgery. The patient went to the supine position with his head tilted to the opposite side, a thin pillow under the shoulder of the affected side, and his upper limbs close to his side. Above the clavicle, the posterior edge of the sternocleidomastoid muscle touches the anterior and middle oblique muscles and the scapula hyoid muscle to form a triangular gap. The base of the triangle can touch the subclavian artery pulse. The puncture point is equivalent to the sixth cervical spine of the cartilage edge. Level. Routine disinfection of skin and laying of sterile towels. The index finger of the left hand is used to fix the skin, and the right hand holds the 7G injection needle, pierce the skin vertically into the ditch, and push it slightly backwards (about C5 transverse process). After passing through the superficial fascia, there is a sense of emptiness. If the patient has a strange feeling at the same time, it is a more reliable sign. If there is no strange feeling, you can slowly insert the needle directly to the C6 transverse process and withdraw the needle slightly. Connect the local anesthesia solution syringe, and draw back no blood, no cerebrospinal fluid, no large amount. The gas can be injected into the local anesthetic 15 ~ 25ml (adult). It is not advisable to perform block on both sides at the same time.

Axillary approach: It is suitable for surgery or reduction of fractures below 1/3 of the upper arm, with side surgery of the hand, wrist and forearm as the first choice. The patient was supine and supine. The affected limb was abducted 90 degrees, the limbs were bent 90 degrees, the back of the hand was close to the head, and the martial arts podium was fully exposed. The axillary artery pulsation was felt at the axillary point. Routine disinfection, put a sterile towel: fix the axillary artery with your left hand, hold the 7G injection needle in your right hand, pierce the skin vertically, diagonally to the axillary direction, the angle between the needle and the artery is 20 degrees, and slowly insert the needle until you feel the fascia empty With the arterial pulsation or strange feeling, the needle is fixed in the left hand, and the local anesthetic liquid syringe prepared in the right hand is drawn back, no blood is drawn, and 20 to 40 ml of the local anesthetic is injected. A spindle-shaped mass may appear in the armpit after injection, which proves that local anesthetic is injected into the axillary sheath and massages the part to help the drug spread.

The supraclavicular method: the patient lies on his back, with a thin pillow under the shoulder of the affected side, his head turned to the opposite side, and the skin is routinely disinfected. Use a local anesthetic to make the skin mound about 1 cm above the midpoint of the collarbone. Use a 6 1 / 2-gauge 3.5 cm injection needle to insert the needle inwards, backwards, and downwards to find the first rib. About 1-3 cm into the rib can puncture the rib. Find the strange feeling along the ribs. No strange feeling can be injected along the ribs.

Local anesthetics commonly used for brachial plexus block anesthesia

1) 1% lidocaine.

2) 2% lidocaine + 0.75% bupivacaine mixture.

3) 2% procaine.

4) 0.5% ropivacaine.

1: 200,000 adrenaline can be added to the above liquid.

The main accidents and complications of brachial plexus block anesthesia and precautions

Local anesthetic poisoning reaction: When the axillary block is blocked, the left hand fixed needle is unstable, causing the puncture needle to enter the axillary artery by mistake. It is a common cause. The intermuscular groove method may mistake the vertebral artery. Prevention and treatment of cervical plexus block .

Intermuscular sulcus method may cause unexpected and complications such as Horner syndrome, recurrent laryngeal nerve and phrenic nerve block, and prevent and treat the same cervical plexus block.

Pneumothorax: Patients with chest tightness after the supraclavicular and supraclavicular block of the intermuscular groove method may have pneumothorax. Auscultation comparison of the two lungs should be performed before and after the block. The respiratory sound of the affected side is significantly reduced. Pneumothorax can be established with dyspnea, and the X-ray examination can confirm the diagnosis. Pneumothorax compression <20% can be further observed. Inhale O2 and wait for natural recovery. If pneumothorax compression is> 20% and there are obvious symptoms, closed drainage should be used.

Intermuscular sulcus has the possibility of entering the subarachnoid space and epidural space by mistake. Observation and monitoring of consciousness, breathing and circulation should be strengthened.

Avoid simultaneous bilateral muscular sulcus method to prevent respiratory depression caused by phrenic nerve and recurrent laryngeal nerve block. Bilateral brachial plexus block anesthesia should be performed. The intermuscular sulcus method on one side and the clavicle method should be used on the other side. Follow the method, strictly control the dosage per unit time, the time between the two medications should be 10 to 40 minutes to prevent local anesthetic poisoning, or one case with 1% lidocaine and 2% procaine on the other side.