New considerations in brachial plexus anesthesia

Understanding relevant brachial plexus anatomy, ensuring precise needle location in the brachial plexus, and injection of appropriate local anesthetic volumes are fundamental to achieving consistent success with brachial plexus anesthesia. Knowledge of brachial plexus anatomy is crucial for understanding resulting distribution of sensory anesthesia and motor blockade, and it minimizes complications as well. The approach to the plexus determines the characteristics of the resulting anesthesia. Recent clinical studies have supported use of high local anesthetic volumes to ensure more complete anesthetic distribution throughout the brachial plexus sheath. Various techniques to access the plexus have been described and can be matched to the approach to enhance clinical success. These include transarterial, paresthesia, and nerve stimulator techniques. Physiological consequences of brachial plexus block may include Horner's syndrome, hoarseness, cough, or phrenic nerve paresis. Side effects and common complications can be explained through a knowledge of the underlying anatomy of the brachial plexus and its anatomical relations. By paying attention to these details, brachial plexus block can be made to work on the same level and scale as general anesthesia, with pronounced benefits for the patient.