title: [Bilateral brachial plexus block. Case report and systematic review].
abstract: BACKGROUND
  The bilateral brachial plexus block is considered a contraindication, due to the possible development of complications, such as: toxicity from local anaesthetics or bilateral diaphragmatic paralysis. However, with the real time visualisation provided by the ultrasound scan, these complications have decreased and it is a safer procedure.
  
  
  METHODS
  Four cases are presented where the bilateral block was performed using guided ultrasound, as the patients were unable to receive general anaesthesia due to a history of adverse effects or the use of opioids in the post-operative or by the prediction of a difficult airway associated with obesity. A systematic review of the literature from January 1993 to June 2013, was also performed by using a search in the MEDLINE, EMBASE, ARTEMISA, LILACS, Google data bases, in Spanish and English language with the following words: bilateral brachial plexus block, bilateral interscalene block, bilateral infraclavicular block, bilateral supraclavicular block, bilateral lateral supraclavicular block, bilateral axillary block, ultrasound-guided bilateral brachial plexus block.
  
  
  CONCLUSIONS
  Based on the evidence found, ultrasound-guided bilateral brachial plexus block in selected patients and expert hands, is no longer a contraindication.
authors.affiliation: División de Anestesiología, Instituto Nacional Rehabilitación, México, D. F., México. Electronic address: gisibyg@yahoo.com.mx.
authors.forename: Gabriel Enrique
authors.initials: GE
authors.lastname: Mejia-Terrazas
authors.affiliation: División de Anestesiología, Instituto Nacional Rehabilitación, México, D. F., México.
authors.forename: María de Ángeles
authors.initials: Mde Á
authors.lastname: Garduño-Juárez
authors.affiliation: División de Anestesiología, Instituto Nacional Rehabilitación, México, D. F., México.
authors.forename: Marisol
authors.initials: M
authors.lastname: Limón-Muñoz
authors.affiliation: División de Anestesiología, Instituto Nacional Rehabilitación, México, D. F., México.
authors.forename: Areli Seir
authors.initials: AS
authors.lastname: Torres-Maldonado
authors.affiliation: Unidad de Cuidados Intensivos, Fundación Clínica Médica Sur, México, D. F., México.
authors.forename: Raúl
authors.initials: R
authors.lastname: Carrillo-Esper
mesh_terms: D000368:Aged; D065527:Brachial Plexus Block / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged
keywords: Bilateral interscalene block; Bilateral supraclavicular block; Bloqueo del plexo braquial bilateral; Bloqueo infraclavicular bilateral; Bloqueo interescalénico bilateral; Bloqueo supraclavicular bilateral; Ecógrafo; Ultrasound bilateral brachial plexus blockM Bilateral Infraclavicular block; Ultrasound scanner