title: Ultrasound-guided regional anesthesia for upper limb surgery.
abstract: OBJECTIVE
  The purpose of this module is to review the main ultrasound-guided approaches used for regional anesthesia of the upper limb.
  
  
  RESULTS
  The anatomical configuration of the upper limb, with nerves often bundled around an artery, makes regional anesthesia of the arm both accessible and reliable. In-depth knowledge of upper limb anatomy is required to match the blocked territory with the surgical area. The interscalene block is the approach most commonly used for shoulder surgery. Supraclavicular, infraclavicular, and axillary blocks are indicated for elbow and forearm surgery. Puncture techniques have evolved dramatically with ultrasound guidance. Instead of targeting the nerves directly, it is now recommended to look for diffusion areas. Typically, local anesthetics are deposited around vessels, often as a single injection. Phrenic nerve block can occur with the interscalene and supraclavicular approaches. Ulnar nerve blockade is almost never achieved with the interscalene approach and not always present with a supraclavicular block. If ultrasound guidance is used, the risk for pneumothorax with a supraclavicular approach is reduced significantly. Nerve damage and vascular puncture are possible with all approaches. If an axillary approach is chosen, the consequences of vascular puncture can be minimized because this site is compressible.
  
  
  CONCLUSIONS
  Upper limb regional anesthesia has gained in popularity because of its effectiveness and the safety profile associated with ultrasound-guided techniques.
authors: Département d'Anesthésie du CHU de Québec, Hôpital de l'Enfant-Jésus, Université Laval, 1401 18e rue, Québec, QC, Canada. marie-josee.nadeau@anr.ulaval.ca
authors: Marie-Josée
authors: MJ
authors: Nadeau
authors: Simon
authors: S
authors: Lévesque
authors: Nicolas
authors: N
authors: Dion
mesh_terms: D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D006801:Humans; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D018084:Ultrasonography, Interventional; D034941:Upper Extremity / Q000033:anatomy & histology / Q000601:surgery
chemical_list: D000779:Anesthetics, Local