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Spinal Nerves: Plexus I

Spinal Nerves: Plexus I

Nerve plexuses are networks of interlacing nerves that serve as communication hubs to distribute and organize nerve action across various body regions. The nerve plexuses are organized into the cervical plexus located in the neck region, brachial plexus in the shoulder area, lumbar plexus found in the lower back, sacral plexus situated in the pelvis, and coccygeal plexus located in the coccygeal region.
The Cervical Plexus
The cervical plexus, formed by the anterior rami of the first four...

Spinal Nerves: Plexus II

Spinal Nerves: Plexus II

The plexuses of the lower body include the lumbar, sacral, and coccygeal plexuses, which innervate the abdomen, pelvis, legs, and coccygeal region. These plexuses control the transmission of sensory information and coordinate motor functions of the lower body.
The Lumbar Plexus
The lumbar plexus is situated within the lumbar region of the back and is primarily formed by the first four lumbar spinal nerves (L1 to L4). This plexus extends its branches into several nerves, including the...

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...

Depolarizing Blockers: Pharmocokinetics

Depolarizing Blockers: Pharmocokinetics

Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...

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Related Experiment Video

Updated: Jun 23, 2026

Ethanol-Induced Cervical Sympathetic Ganglion Block Applications for Promoting Canine Inferior Alveolar Nerve Regeneration Using an Artificial Nerve

Ethanol-Induced Cervical Sympathetic Ganglion Block Applications for Promoting Canine Inferior Alveolar Nerve Regeneration Using an Artificial Nerve

Published on: November 30, 2018

Phrenic nerve block after interscalene brachial plexus block. Case report.

Luis Henrique Cangiani¹, Luis Augusto Edwards Rezende, Armando Giancoli Neto

¹Centro Médico de Campinas, Hospital sede do CET/SBA em Anestesiologia do Instituto Penido Burnier, Campinas, SP. cangianilh@gmail.com

Revista Brasileira De Anestesiologia

|April 22, 2009

Summary

Phrenic nerve block during brachial plexus anesthesia can cause respiratory issues, as seen in a patient with chronic renal failure undergoing arteriovenous fistula creation. While temporary, this complication highlights the need for careful patient selection for interscalene brachial plexus blocks.

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Published on: October 20, 2021

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Last Updated: Jun 23, 2026

Ethanol-Induced Cervical Sympathetic Ganglion Block Applications for Promoting Canine Inferior Alveolar Nerve Regeneration Using an Artificial Nerve

Ethanol-Induced Cervical Sympathetic Ganglion Block Applications for Promoting Canine Inferior Alveolar Nerve Regeneration Using an Artificial Nerve

Published on: November 30, 2018

Implantation and Control of Wireless, Battery-free Systems for Peripheral Nerve Interfacing

Implantation and Control of Wireless, Battery-free Systems for Peripheral Nerve Interfacing

Published on: October 20, 2021

Area of Science:

Anesthesiology
Nephrology
Pulmonology

Background:

Phrenic nerve block is a known complication of brachial plexus blocks.
This case highlights significant respiratory repercussions in a patient with multiple comorbidities.

Observation:

A patient with chronic renal failure, COPD, and other conditions developed dyspnea and unilateral respiratory changes after an interscalene brachial plexus block.
Chest X-ray confirmed right hemidiaphragm elevation, indicating phrenic nerve paralysis.

Findings:

The patient experienced complete paralysis of the right phrenic nerve, leading to respiratory distress.
Non-invasive oxygen support was sufficient, and the patient recovered fully within three hours.

Implications:

This case underscores the potential for severe phrenic nerve block complications, even if transient.
Anesthesiologists should exercise caution when performing interscalene brachial plexus blocks in patients with compromised respiratory function or extensive arteriovenous fistulas.