Methods of anesthesia of the brachial plexus

The article is written by Specialist I Tran Thi Anh Hien - Anesthesiologist, Anesthesiology Department - Vinmec Central Park International Hospital

Brachial plexus anesthesia is a regional anesthetic technique that is performed by applying local anesthetic to the brachial plexus area to reduce pain sensation in the brachial plexus.

Currently, the trend in the world is to anesthetize the brachial plexus under ultrasound guidance. Anesthesiologists accurately identify the nerve to be numbed and surrounding structures, avoiding puncture of blood vessels. Then inject local anesthetic and assess the degree of blockade of the anesthetic. As a result, complications and complications such as nerve damage, injecting drugs into the blood vessels, causing poisoning of local anesthetics, injecting drugs at the wrong position, lead to technical failures. When the anesthetic in surgery wears off, a continuous anesthetic can be infused through the catheter to reduce postoperative pain.
This is a new technique, outstanding with many advantages:
Safety, few complications, complications Quick and accurate operation, high success rate Good pain relief results Less impact on vitals: Heart rate, blood pressure and oxygen saturation Reduce side effects of anesthesia and complications when anesthesia, especially patients with cardiovascular disease, chronic obstructive pulmonary disease, bronchial asthma... No need to use Morphine and morphine precursors, helping to avoid the side effects of Morphin such as: nausea, vomiting, urinary retention, constipation, addiction. Patients recover soon after surgery, improve quality of life. low fee

Indications for surgery
Surgery on the upper extremities from shoulder to hand especially for patients with contraindications to general anesthesia. Indications for medical therapy
Treatment of pain caused by neuritis (shingles) or pain in the stumps. Pain in the hand due to exercise. Cases of ischemia of the upper extremities cause pain. Contraindications
Patient disagrees. The patient is allergic to the anesthetic. Infection of the anesthetic area. Epilepsy patients, psychiatric patients... Do not anesthetize both sides at the same time because it is easy to lead to anesthetic poisoning due to overdose. Do not anesthetize ACL on the clavicle when there is pathology in the opposite lung (hemorrhage). , pneumothorax...)

Indications: surgery of clavicle, shoulder joint, upper humerus Patient position: supine, head turned to the opposite side of anesthesia Ultrasound probe position: use a straight transducer placed in cross-section 3-4 cm above the clavicle and lateral to the jugular vein Objective: Anesthesia spread between the anterior and middle scalene muscles, encircling the upper body and the middle brachial plexus Volume of anesthetic: 7-15 ml

Indications: surgery from the lower arm to the hand Patient position: supine, head turned to the opposite side of anesthesia Ultrasound probe position: use a straight transducer placed in the upper and middle position clavicle Target: local anesthetic surrounding brachial plexus, posterior superior subclavian artery Volume of anesthetic: 20 ml

Indications: operate from elbow to hand Patient position: supine, arm 90 degrees Position of ultrasound transducer: use a straight transducer placed along the short axis of the arm and cross the distal pectoralis major. Digestion: local anesthetic surrounds the axillary artery

Volume of local anesthetic: 15-20 ml

Due to mechanical effects (needles), anesthetic poisoning, or vasoconstriction of adrenaline, causing ischemia, causing sensory disturbances in an area of ​​the skin controlled by nerves, after a while the sensory disturbances will disappear To avoid These complications should be noted: Do not try to feel paresthesia Do not inject anesthetic when the patient complains of pain from nerve puncture Do not use concentrated anesthetic solutions If punctured an artery, press firmly on it about 5 minutes to avoid causing hematoma to press on the nerves

Numbness of the stellate ganglion during supraclavicular anesthesia causes Claude Bernard Honer syndrome. Red face, constricted pupils, concave eyes, increased skin temperature, stuffy nose (with anesthesia). Numbness of the phrenic nerve is performed with interskeletal and supraclavicular anesthesia. Respiratory failure due to paralysis of the diaphragm. Treatment: oxygen breathing or artificial ventilation Recurrent neuropathy: hoarseness → The symptoms will disappear when the effect of the anesthetic wears off

Puncture of the epidural or subarachnoid space Symptoms: Hypotension, cardiac arrest, respiratory failure, respiratory arrest. Treatment: Endotracheal intubation, controlled breathing, extrathoracic compression, vasoconstrictor drug poisoning Anesthesia poisoning: due to overdose or injecting anesthetic into blood vessels Symptoms: Numbness of tongue, mild headache, visual disturbances, convulsions, coma, apnea, bradycardia, cardiac arrest. Treatment: Lipofundin 20%, Midazolam, respiratory control intubation if necessary. Atropin if bradycardia, vasoconstrictor, intravenous fluids. Pneumothorax Definitive diagnosis is based on chest X-ray. Treatment: Aspiration, drainage of the pleural cavity continuous suction Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading medical doctors, equipment system. modern technology but also outstanding with comprehensive and professional medical examination, consultation and treatment services; civilized, polite, safe and sterile medical examination and treatment space.
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