Hadzic's Regional Anesthesia > Part III. Clinical Practice of Regional Anesthesia > Section Five. Upper Extremity Nerve Blocks > Chapter 31. Cutaneous Blocks for the Upper Extremity Joseph M. Neal, MD

Cutaneous Blocks for the Upper Extremity: Introduction

"Although most upper extremity regional anesthesia is accomplished by means of various approaches to the brachial plexus, there are occasions when individual terminal nerves or their branches are blocked selectively. There are generally three instances in which the anesthesiologist desires to perform these selective nerve blocks. First, some surgical sites are partially innervated by sensory nerves that are not part of the brachial plexus or not consistently anesthetized with plexus blocks. This chapter describes how and when to anesthetize the most common of these nerves—the supraclavicular, the suprascapular, and the intercostobrachial. The second indication is when blocking the entire brachial plexus block is not necessary for the planned procedure. In this case, selective upper extremity cutaneous anesthesia or analgesia may involve blocking terminal nerves (radial, median, or ulnar nerves) or their branches (lateral and medial antebrachial cutaneous nerves) distally at the elbow. A final and controversial indication for selective upper extremity nerve blocks is their use as a supplement to an incomplete brachial plexus block.Local anesthetics for individual upper extremity nerve blocks are selected for their desired duration of anesthesia and/or analgesia. If intermediate-acting local anesthetics are selected (lidocaine or mepivacaine), duration can be increased with either adjuvant epinephrine (2.5 mcg/mL) or clonidine (0.5 mcg/kg). Neither adjuvant significantly increases duration when a long-acting local anesthetic such as bupivacaine..."