Abstract

Despite the potential complications of brachial plexus blockade, it remains a reliable and safe form of anesthesia for surgery of the upper extremity. The site of the surgery dictates which of the four approaches to the brachial plexus should be used. When the choice matches the site of surgery, the blocks should be successful in approximately 80% of cases. When supplemented with an additional peripheral block, the success rate is greater than 90% using the axillary and supraclavicular approaches. The duration of the blocks varies from 1 to 12 hours, depending on the choice of anesthetic agent. The addition of epinephrine to the anesthetic agent decreases the rate of tissue uptake of the drug, thereby both lengthening the duration of the block and decreasing the toxicity of the agent. Alkalinizing lidocaine with sodium bicarbonate decreases the latency time and increases the intensity and spread of the block. Surgeons should be aware of the advantages and capabilities of regional anesthesia and should discuss anesthesia options with patients and anesthesiologists.