title: Upper-extremity peripheral nerve blocks in the perioperative pain management of orthopaedic patients: AAOS exhibit selection.
abstract: BACKGROUND
  Over the past twenty-five years, peripheral nerve blocks have become increasingly common for the management of perioperative pain of the upper extremity. Several factors have led to increasing acceptance and use of these peripheral nerve blocks, including a greater awareness and measurement of patient pain and a greater emphasis on decreasing the duration of hospital stays and associated costs.
  
  
  METHODS
  We present a review of peripheral nerve blocks for procedures involving the upper extremity, including indications, contraindications, anatomy and technique, expected clinical outcomes and the associated levels of evidence, cost-effectiveness, and complications. We reviewed the scientific literature for studies on the effectiveness of peripheral nerve blocks for orthopaedic procedures involving the upper extremity. Particular attention was directed at the most commonly used nerve blocks, the levels of evidence supporting their use, and emerging technologies such as ultrasonographic guidance.
  
  
  RESULTS
  Peripheral nerve blocks for upper-extremity procedures improve postoperative pain control and patient satisfaction, can be administered safely, and have a low complication rate. They are also associated with enhanced participation in postoperative rehabilitation, decreased hospital stays, and decreased costs. There are increasingly higher levels of evidence in the literature to support the use of peripheral nerve blocks in a wide variety of orthopaedic procedures ranging from the shoulder to the hand.
  
  
  CONCLUSIONS
  The use of peripheral nerve blocks in upper-extremity surgery is common. To actively participate with the patient and anesthesiologist to ensure the best possible outcomes, the orthopaedic surgeon must be well informed regarding the benefits and limitations of this modality.
authors.affiliation: c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave. #A665, Baltimore, MD 21224-2780. E-mail address for E.P. Henze: ehenze1@jhmi.edu.
authors.forename: Umasuthan
authors.initials: U
authors.lastname: Srikumaran
authors.affiliation: c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave. #A665, Baltimore, MD 21224-2780. E-mail address for E.P. Henze: ehenze1@jhmi.edu.
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Stein
authors.affiliation: c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave. #A665, Baltimore, MD 21224-2780. E-mail address for E.P. Henze: ehenze1@jhmi.edu.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Tan
authors.affiliation: c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave. #A665, Baltimore, MD 21224-2780. E-mail address for E.P. Henze: ehenze1@jhmi.edu.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Freehill
authors.affiliation: c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave. #A665, Baltimore, MD 21224-2780. E-mail address for E.P. Henze: ehenze1@jhmi.edu.
authors.forename: John H
authors.initials: JH
authors.lastname: Wilckens
mesh_terms: D006801:Humans; D009407:Nerve Block / Q000379:methods*; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D017060:Patient Satisfaction; D034941:Upper Extremity / Q000601:surgery*