Language
Country/Area
No result found
Brachial plexus block versus general anesthesia: which option is safer?
Brachial plexus block is a regional anesthetic technique that is often performed as an alternative or adjunct to upper extremity surgery. This technique involves injecting a local anesthetic near the brachial plexus, temporarily blocking sensation and movement in the upper limb. During the procedure, the patient can remain awake, sedated, or under full anesthesia as needed.
One of the advantages of a brachial plexus block is that it reduces the risks and side effects of general anesthesia.
Brachial plexus block technique
Brachial plexus blocks are performed by an anesthesiologist. To achieve optimal block, the needle tip should be placed as close to the brachial plexus as possible. Commonly used techniques include transarterial puncture, eliciting paresthesias, and using peripheral nerve stimulators or portable ultrasound scanning devices. These techniques can effectively improve the anesthesia effect.
Indications for surgery
General anesthesia may cause adverse effects such as hypotension, decreased cardiac output, and central nervous system depression, while brachial plexus block helps to avoid these potential complications.
Brachial plexus blocks are often used for surgery from the shoulder to the fingers and can effectively avoid many complications of general anesthesia.
Anatomy of the Brachial Plexus
The brachial plexus formation consists of ventral branches from C5 to T1. Several block techniques for this nerve are divided into the cervical compartment block of the neck, the supraclavicular block, the infraclavicular block, and the axillary block, depending on where the needle is injected with the local anesthetic. Each technique has specific indications, advantages and disadvantages.
Comparison of different blocking techniques
Neck space block
This method is mainly used in surgeries of the clavicle, shoulder, and arm. Although the cervical space block has the advantage of rapid blockade of the shoulder region, it is less effective in anesthetizing the axillary nerve in the arm and hand.
Supraclavicular block
This technique provides rapid and durable anesthesia, ideal for operations involving the arm and forearm.
Supraclavicular blocks generally have higher success rates than other approaches and require greater care to avoid pulmonary complications when performed.
Subclavian block
Based on the latest evidence, the dual stimulation technique is considered superior to single stimulation in the Achilles report.
Axillary block
This method is particularly suitable for surgeries on the elbow, forearm, wrist and hand. It is relatively safe, but the anesthetic effect on extra-tendinous nerves needs to be strengthened.
Complications and risks
All nerve block techniques carry a certain risk of complications, such as infection, bleeding, and toxic reactions to local anesthetics. The risk of complications increases significantly, especially in patients taking anticoagulants.
The most common complication of brachial plexus block techniques is pneumothorax, particularly if the needle tip approaches the lung.
When considering anesthetic techniques, in addition to safety, the patient's needs, the physician's experience, and the specific circumstances of the surgery must also be considered.
SummaryWith advances in anesthesiology, brachial plexus blocks have become more widely used and have provided a safer and more effective surgical experience for many patients. When choosing anesthesia techniques, how do patients and medical teams balance risks and benefits? This is a question worth pondering.
