Hadzic Chapter 7

Question 1

What is the indication for an Interscalene brachial plexus block?

Answer 1

Shoulder surgery, frozen shoulder mobilization, upper arm and humerus surgery.

Question 2

What are the advantages of the Interscalene brachial plexus block?

Answer 2

Distal spread toward the supraclavicular nerves; may spare the lower trunk and partially preserve the mobility of the hand.

Question 3

What are the disadvantages of the Interscalene brachial plexus block?

Answer 3

Hemidiaphragmatic paralysis due to spread toward the phrenic nerve; complex plexus architecture carries a higher risk of transient neuropathies; spares the lower trunk, not recommended for elbow surgery and below; side effects include Horner syndrome and recurrent laryngeal nerve block.

Question 4

What is the indication for a Supraclavicular brachial plexus block?

Answer 4

Shoulder surgery (if the upper trunk is blocked); surgery of the arm, forearm, and hand.

Question 5

What are the advantages of the Supraclavicular brachial plexus block?

Answer 5

Anesthesia of the whole arm including the shoulder with a single block; fast onset.

Question 6

What are the disadvantages of the Supraclavicular brachial plexus block?

Answer 6

Hemidiaphragmatic paralysis due to rostral spread of local anesthetic; risk of pneumothorax and vascular puncture; pectoral, musculocutaneous, and subscapular nerves are not covered; requires a greater degree of expertise.

Question 7

What is the indication for a Costoclavicular block?

Answer 7

Shoulder surgery; surgery of the arm, forearm, and hand.

Question 8

What are the advantages of the Infraclavicular brachial plexus block?

Answer 8

Convenient for catheter placement; less incidence of phrenic nerve block; less risk of pneumothorax than supraclavicular approaches.

Question 9

What are the disadvantages of the Infraclavicular brachial plexus block?

Answer 9

Deep block; requires a higher volume of local anesthetic to block the three cords of the brachial plexus; intercostobrachial nerve block may be needed; adequate US imaging may be challenging in obese patients.

Question 10

What is a shoulder block?

Answer 10

A shoulder block involves the suprascapular nerve and axillary nerve block, used for shoulder surgery and frozen shoulder mobilization.

Question 11

What are the disadvantages of a shoulder block?

Answer 11

Disadvantages include challenges in adequate ultrasound imaging in obese patients, coverage not including the pectoral, musculocutaneous, and subscapular nerves, and requiring a greater degree of expertise.

Question 12

What are the advantages of a costoclavicular block?

Answer 12

It provides a consistent block of the three cords of the brachial plexus, is phrenic nerve-sparing, and has a less incidence of phrenic nerve block.

Question 13

What is a disadvantage of the costoclavicular block?

Answer 13

Adequate ultrasound imaging may be challenging in obese patients. And also requires a greater degrees of expertise

Question 14

What is infraclavicular brachial plexus block used for?

Answer 14

Surgery of the arm distal to the axilla