Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Anesthesiology, University of Washington Medical Center, University of Washington, Seattle, WA, USA.
Best Pract Res Clin Anaesthesiol. 2020 Mar;34(1):e13-e29. doi: 10.1016/j.bpa.2019.07.005. Epub 2019 Jul 20.
Surgeries and chronic pain states of the upper extremity are quite common and pose unique challenges for the clinical anesthesiology and pain specialists. Most innervation of the upper extremity involves the brachial plexus. The four most common brachial plexus blocks performed in clinical setting include the interscalene, supraclavicular, infraclavicular, and axillary brachial plexus blocks. These blocks are most commonly performed with the use of ultrasound-guided techniques, whereby analgesia is achieved by anesthetizing the brachial plexus at different levels such as the roots, divisions, cords, and branches. Additional regional anesthetic techniques for upper extremity surgery include wrist, intercostobrachial, and digital nerve blocks, which are most frequently performed using landmark anatomical techniques. This review provides a comprehensive summary of each of these blocks including anatomy, best practice techniques, and potential complications.
上肢的手术和慢性疼痛状态较为常见，给临床麻醉和疼痛专家带来了独特的挑战。上肢的大多数神经支配都涉及臂丛。在临床环境中进行的四种最常见的臂丛神经阻滞包括肌间沟、锁骨上、锁骨下和腋窝臂丛神经阻滞。这些阻滞最常使用超声引导技术进行，通过在不同水平（如神经根、分支、神经索和分支）麻醉臂丛神经来实现镇痛。上肢手术的其他区域麻醉技术包括腕部、肋间臂神经和指神经阻滞，这些技术最常使用地标解剖技术进行。本文综述了每一种阻滞技术，包括解剖学、最佳实践技术和潜在的并发症。
