Upper extremity nerve block: how can benefit, duration, and safety be improved? An update

Area of Science:

• Anesthesiology
• Regional Anesthesia
• Pain Management

Background:

• Upper extremity blocks are valuable for anesthesia and postoperative pain relief, reducing opioid requirements.
• There is a resurgence in interest in various plexus blocks (interscalene, supraclavicular, infraclavicular, axillary) due to ultrasound guidance.

Purpose of the Study:

• To review the utility of ultrasound-guided upper extremity blocks.
• To discuss methods for prolonging postoperative analgesia from these blocks.

Main Methods:

• Review of current literature on ultrasound-guided upper extremity blocks.
• Discussion of adjuncts and continuous infusion techniques for extended analgesia.

Main Results:

• Ultrasound guidance enhances safety and efficacy, reducing complications and required anesthetic volume.
• Single-shot blocks provide effective but limited duration of analgesia.
• Continuous perineural infusion via catheters effectively prolongs postoperative pain relief and improves quality.

Conclusions:

• Ultrasound-guided upper extremity blocks are effective as sole anesthesia or adjuncts, decreasing intraoperative analgesic and hypnotic needs.
• Continuous perineural infusion is a viable strategy to extend the benefits of these blocks for improved postoperative pain management.