Der Anaesthesist

, Volume 52, Issue 7, pp 643–657 | Cite as

Plexus brachialis

Anästhesie und Analgesie
Weiterbildung: Zertifizierte Fortbildung

Zusammenfassung

Diese Übersicht stellt die gebräuchlichsten Zugangswege zum Plexus brachialis (zervikal-posterior, interskalenär, supra- und infraklavikulär und axillär) dar und erläutert die Vor- und Nachteile (Indikationen, Kontraindikationen, Komplikationen) der einzelnen Methoden. Dabei wird die Anwendung für die chirurgische Anästhesie ebenso wie für die postoperative Analgesie oder chronische Schmerztherapie, insbesondere hinsichtlich kontinuierlicher Kathetertechniken, erläutert. Hinweise finden sich zu den am häufigsten verwendeten Lokalanästhetika und zu Zusätzen, die bei der Plexusanästhesie in der Literatur beschrieben werden. Ein wesentlicher Schwerpunkt des Beitrages sind darüber hinaus die organisatorischen Strukturen für die erfolgreiche Anwendung der Technik und die erforderliche Dokumentation. Insgesamt stellen Single-Shot- und kontinuierliche regionalanästhesiologische Techniken zur Blockade des Plexus brachialis ein effizientes und nebenwirkungsarmes Verfahren zur Anästhesie und Analgesie für den Schulter-Arm-Bereich dar.

Schlüsselwörter

Plexus brachialis Axillärer Block Infraklavikulärer Block Supraklavikulärer Block Interskalenärer Block Zervikal-posteriorer Block 

Abstract

This review explains the different approaches to the brachial plexus (posterior cervical, interscalene, supra- and infraclavicular, and axillary) and their advantages and disadvantages (indications, contraindications, and complications) for surgery and postoperative or chronic pain management. One of the focussed areas of this review is the use of continuous catheter techniques. Information about the most commonly used local anesthetics as well as adjuncts suggested in the literature is summarized. As essential components for the success of those techniques, organizational and documentation requirements are described. In summary, regional techniques for single shot or continuous block of the brachial plexus are an efficient and safe way of providing anesthesia and analgesia for surgery or pain in the region of the shoulder, arm, or hand.

Keywords

Brachial plexus Posterior cervical Interscalene Supraclavicular Infraclavicular Axillary 

Literatur

  1. 1.
    Azad SC, Beyer A, Romer AW et al. (2000) Continuous axillary brachial plexus analgesia with low dose morphine in patients with complex regional pain syndromes. Eur J Anaesthesiol 17:185–188CrossRefPubMedGoogle Scholar
  2. 2.
    Bazin JE, Massoni C, Bruelle P et al. (1997) The addition of opioids to local anaesthetics in brachial plexus block: the comparative effects of morphine, buprenorphine and sufentanil. Anaesthesia 52:858–862PubMedGoogle Scholar
  3. 3.
    Bazin JE, Massoni C, Groslier D et al. (1997) Brachial plexus block: effect of the addition of sufentanil to local anesthetic mixture on postoperative analgesia duration. Ann Fr Anesth Reanim 16:9–13CrossRefPubMedGoogle Scholar
  4. 4.
    Benumof JL (2000) Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia. Anesthesiology 93:1541–1544PubMedGoogle Scholar
  5. 5.
    Bergman BD, Hebl JR, Kent J, Horlocker TT (2003) Neurologic complications of 405 consecutive continuous axillary catheters. Anesth Analg 96:247–252PubMedGoogle Scholar
  6. 6.
    Bernard JM, Macaire P (1997) Dose-range effects of clonidine added to lidocaine for brachial plexus block. Anesthesiology 87:277–284PubMedGoogle Scholar
  7. 7.
    Bertini L, Tagariello V, Mancini S et al. (1999) 0.75% and 0.5% ropivacaine for axillary brachial plexus block: a clinical comparison with 0.5% bupivacaine. Reg Anesth Pain Med 24:514–518PubMedGoogle Scholar
  8. 8.
    Boezaart AP (2002) Continuous interscalene block for ambulatory shoulder surgery. Best Pract Res Clin Anaesthesiol 16:295–310CrossRefPubMedGoogle Scholar
  9. 9.
    Boezaart AP, de Beer JF, du Toit C, van Rooyen K (1999) A new technique of continuous interscalene nerve block. Can J Anaesth 46:275–281PubMedGoogle Scholar
  10. 10.
    Boezaart AP, Koorn R, Borene S, Edwards JN (2003) Continuous brachial plexus block using the posterior approach. Reg Anesth Pain Med 28:70–71Google Scholar
  11. 11.
    Bone HG, Van Aken H, Booke M, Burkle H (1999) Enhancement of axillary brachial plexus block anesthesia by coadministration of neostigmine. Reg Anesth Pain Med 24:405–410PubMedGoogle Scholar
  12. 12.
    Borgeat A, Ekatodramis G, Schenker CA, Warltier DC (2003) Postoperative nausea and vomiting in regional anesthesia: a review. Anesthesiology 98:530–547PubMedGoogle Scholar
  13. 13.
    Bosenberg AT, Raw R, Boezaart AP (2002) Surface mapping of peripheral nerves in children with a nerve stimulator. Paediatr Anaesth 12:398–403CrossRefPubMedGoogle Scholar
  14. 14.
    Bouaziz H, Kinirons BP, Macalou D et al. (2000) Sufentanil does not prolong the duration of analgesia in a mepivacaine brachial plexus block: a dose response study. Anesth Analg 90:383–387PubMedGoogle Scholar
  15. 15.
    Brown AR (2002) Anaesthesia for procedures of the hand and elbow. Best Pract Res Clin Anaesthesiol 16:227–246CrossRefPubMedGoogle Scholar
  16. 16.
    Brown DL, Cahill DR, Bridenbaugh LD (1993) Supraclavicular nerve block: anatomic analysis of a method to prevent pneumothorax. Anesth Analg 76:530–534PubMedGoogle Scholar
  17. 17.
    Candido KD, Winnie AP, Covino BG et al. (1995) Addition of bicarbonate to plain bupivacaine does not significantly alter the onset or duration of plexus anesthesia. Reg Anesth 20:133–138PubMedGoogle Scholar
  18. 18.
    Candido KD, Franco CD, Khan MA et al. (2001) Buprenorphine added to the local anesthetic for brachial plexus block to provide postoperative analgesia in outpatients. Reg Anesth Pain Med 26:352–356CrossRefPubMedGoogle Scholar
  19. 19.
    Candido KD, Winnie AP, Ghaleb AH et al. (2002) Buprenorphine added to the local anesthetic for axillary brachial plexus block prolongs postoperative analgesia. Reg Anesth Pain Med 27:162–167CrossRefPubMedGoogle Scholar
  20. 20.
    Carles M, Pulcini A, Macchi P et al. (2001) An evaluation of the brachial plexus block at the humeral canal using a neurostimulator (1417 patients): the efficacy, safety, and predictive criteria of failure. Anesth Analg 92:194–198PubMedGoogle Scholar
  21. 21.
    Carre P, Joly A, Cluzel Field B et al. (2000) Axillary block in children: single or multiple injection? Paediatr Anaesth 10:35–39Google Scholar
  22. 22.
    Casati A, Fanelli G, Cedrati V et al. (1999) Pulmonary function changes after interscalene brachial plexus anesthesia with 0.5% and 0.75% ropivacaine: a double-blinded comparison with 2% mepivacaine. Anesth Analg 88:587–592PubMedGoogle Scholar
  23. 23.
    Cheney FW, Domino KB, Caplan RA, Posner KL (1999) Nerve injury associated with anesthesia: a closed claims analysis. Anesthesiology 90:1062–1069PubMedGoogle Scholar
  24. 24.
    Chilvers CR (1993) Warm local anaesthetic-effect on latency of onset of axillary brachial plexus block. Anaesth Intensive Care 21:795–798PubMedGoogle Scholar
  25. 25.
    Chow MY, Sia AT, Koay CK, Chan YW (1998) Alkalinization of lidocaine does not hasten the onset of axillary brachial plexus block. Anesth Analg 86:566–568PubMedGoogle Scholar
  26. 26.
    Choyce A, Chan VW, Middleton WJ et al. (2001) What is the relationship between paresthesia and nerve stimulation for axillary brachial plexus block? Reg Anesth Pain Med 26:100–104Google Scholar
  27. 27.
    Cornish PB, Greenfield LJ (1997) Brachial plexus anatomy. Reg Anesth 22:106–107PubMedGoogle Scholar
  28. 28.
    Cuvillon P, Ripart J, Lalourcey L et al. (2001) The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects. Anesth Analg 93:1045–1049PubMedGoogle Scholar
  29. 29.
    D'Ambrosio A, De Negri P, Damato A et al. (2001) S-bupivacaine (levobupivacaine) in peripheral blocks: preliminary results. Minerva Anestesiol 67:37–43PubMedGoogle Scholar
  30. 30.
    De Andres J, Sala-Blanch X (2001) Peripheral nerve stimulation in the practice of brachial plexus anesthesia: a review. Reg Anesth Pain Med 26:478–483CrossRefPubMedGoogle Scholar
  31. 31.
    De Andres J, Sala-Blanch X (2002) Ultrasound in the practice of brachial plexus anesthesia. Reg Anesth Pain Med 27:77–89CrossRefPubMedGoogle Scholar
  32. 32.
    do Nascimento P Jr, Modolo NS, Meletti JF, Braz JR (1998) Sympathetic hyperactivity, respiratory failure, pruritus, and anesthesia after unintentional epidural injection of potassium chloride: case report. Reg Anesth Pain Med 23:219–222PubMedGoogle Scholar
  33. 33.
    Dupre LJ (1994) Brachial plexus block through humeral approach. Can Anesthesiol 42:767–769Google Scholar
  34. 34.
    El Saied AH, Steyn MP, Ansermino JM (2000) Clonidine prolongs the effect of ropivacaine for axillary brachial plexus blockade. Can J Anaesth 47:962–967PubMedGoogle Scholar
  35. 35.
    Erlacher W, Schuschnig C, Koinig H et al. (2001) Clonidine as adjuvant for mepivacaine, ropivacaine and bupivacaine in axillary, perivascular brachial plexus block. Can J Anaesth 48:522–525PubMedGoogle Scholar
  36. 36.
    Fanelli G, Casati A, Garancini P, Torri G (1999) Nerve stimulator and multiple injection technique for upper and lower limb blockade: failure rate, patient acceptance, and neurologic complications. Study Group on Regional Anesthesia. Anesth Analg 88:847–852PubMedGoogle Scholar
  37. 37.
    Foster RH, Markham A (2000) Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs 59:551–579PubMedGoogle Scholar
  38. 38.
    Frizelle HP, Moriarty DC (1998) The "midhumeral" approach to the brachial plexus. Anesth Analg 86:447–448Google Scholar
  39. 39.
    Gaertner E, Kern O, Mahoudeau G et al. (1999) Block of the brachial plexus branches by the humeral route. A prospective study in 503 ambulatory patients. Proposal of a nerve-blocking sequence. Acta Anaesthesiol Scand 43:609–613CrossRefPubMedGoogle Scholar
  40. 40.
    Gentili ME, Wargnier JP, Caillon FC (1990) Peripheral neurologic complications of brachial plexus blocks. Cah Anesthesiol 38:561–567PubMedGoogle Scholar
  41. 41.
    Gottardis M, Luger T, Florl C et al. (1993) Spirometry, blood gas analysis and ultrasonography of the diaphragm after Winnie's interscalene brachial plexus block. Eur J Anaesthesiol 10:367–369PubMedGoogle Scholar
  42. 42.
    Heath PJ, Brownlie GS, Herrick MJ (1990) Latency of brachial plexus block. The effect on onset time of warming local anaesthetic solutions. Anaesthesia 45:297–301PubMedGoogle Scholar
  43. 43.
    Hempel V (1999) Anästhesie des Plexus brachialis. Anaesthesist 48:341–355CrossRefPubMedGoogle Scholar
  44. 44.
    Hirschel G (1911) Anästhesierung des Plexus brachialis bei Operationen der oberen Extremität. Münch Med Wochenschr 58:1555–1556Google Scholar
  45. 45.
    Hofmann-Kiefer K, Herbrich C, Seebauer A et al. (2002) Ropivacaine 7.5 mg/ml versus bupivacaine 5 mg/ml for interscalene brachial plexus block-a comparative study. Anaesth Intensive Care 30:331–337PubMedGoogle Scholar
  46. 46.
    Iskandar H, Guillaume E, Dixmerias F et al. (2001) The enhancement of sensory blockade by clonidine selectively added to mepivacaine after midhumeral block. Anesth Analg 93:771–775PubMedGoogle Scholar
  47. 47.
    Kapral S, Gollmann G, Waltl B et al. (1999) Tramadol added to mepivacaine prolongs the duration of an axillary brachial plexus blockade. Anesth Analg 88:853–856PubMedGoogle Scholar
  48. 48.
    Karakaya D, Buyukgoz F, Baris S et al. (2001) Addition of fentanyl to bupivacaine prolongs anesthesia and analgesia in axillary brachial plexus block. Reg Anesth Pain Med 26:434–438CrossRefPubMedGoogle Scholar
  49. 49.
    Kilka HG, Geiger P, Mehrkens HH (1995) Die vertikale infraklavikuläre Blockade des Plexus brachialis. Anaesthesist 44:339–344CrossRefPubMedGoogle Scholar
  50. 50.
    Klein SM, Greengrass RA, Steele SM et al. (1998) A comparison of 0.5% bupivacaine, 0.5% ropivacaine, and 0.75% ropivacaine for interscalene brachial plexus block. Anesth Analg 87:1316–1319PubMedGoogle Scholar
  51. 51.
    Koscielniak-Nielsen ZJ, Stens-Pedersen HL, Lippert FK (1997) Readiness for surgery after axillary block: single or multiple injection techniques. Eur J Anaesthesiol 14:164–171PubMedGoogle Scholar
  52. 52.
    Koscielniak-Nielsen ZJ, Rassmussen H, Jepsen K (2001) Effect of impulse duration on patients' perception of electrical stimulation and block effectiveness during axillary block in unsedated ambulatory patients. Reg Anesth Pain Med 26:428–433CrossRefPubMedGoogle Scholar
  53. 53.
    Krenn H, Deusch E, Balogh B et al. (2003) Increasing the injection volume by dilution improves the onset of motor blockade, but not sensory blockade of ropivacaine for brachial plexus block. Eur J Anaesthesiol 20:21–25PubMedGoogle Scholar
  54. 54.
    Kulenkampff D (1911) Die Anästhesierung des Plexus brachialis. Zentralbl Chir 38:1337Google Scholar
  55. 55.
    Kulenkampff D (1912) Die Anästhesierung des Plexus brachialis. Dtsch Med Wochenschr 38:1878–1880Google Scholar
  56. 56.
    Lee IO, Kim WK, Kong MH et al. (2002) No enhancement of sensory and motor blockade by ketamine added to ropivacaine interscalene brachial plexus blockade. Acta Anaesthesiol Scand 46:821–826CrossRefPubMedGoogle Scholar
  57. 57.
    Lepage C, Drolet P, Girard M et al. (2001) Music decreases sedative requirements during spinal anesthesia. Anesth Analg 93:912–916PubMedGoogle Scholar
  58. 58.
    Marhofer P, Glaser C, Koinig H et al. (1998) The use of ropivacaine in brachial plexus anaesthesia. Anaesthesia 53 [Suppl 2]:14–15Google Scholar
  59. 59.
    Markham A, Faulds D (1996) Ropivacaine. A review of its pharmacology and therapeutic use in regional anaesthesia. Drugs 52:429–449PubMedGoogle Scholar
  60. 60.
    McClellan KJ, Faulds D (2000) Ropivacaine: an update of its use in regional anaesthesia. Drugs 60:1065–1093PubMedGoogle Scholar
  61. 61.
    McGlade DP, Kalpokas MV, Mooney PH et al. (1998) A comparison of 0.5% ropivacaine and 0.5% bupivacaine for axillary brachial plexus anaesthesia. Anaesth Intensive Care 26:515–520PubMedGoogle Scholar
  62. 62.
    Meier G, Bauereis C, Heinrich C (1997) Der interskalenäre Plexus-brachialis-Katheter zur Anästhesie und postoperativen Schmerzbehandlung—Erfahrungen mit einer modifizierten Technik. Anaesthesist 46:715–719CrossRefPubMedGoogle Scholar
  63. 63.
    Meier G, Bauereis C, Maurer H, Meier T (2001) Interskalenäre Plexusblockade: Anatomische Voraussetzungen—anästhesiologische und operative Aspekte. Anaesthesist 50:333–341CrossRefPubMedGoogle Scholar
  64. 64.
    Nadig M, Ekatodramis G, Borgeat A (2002) What to do with clonidine with long-acting local anesthetic in brachial plexus block? Anesth Analg 95:254; author reply 254Google Scholar
  65. 65.
    Neal JM (2001) How close is close enough? Defining the "paresthesia chad". Reg Anesth Pain Med 26:97–99CrossRefPubMedGoogle Scholar
  66. 66.
    Nishikawa K, Kanaya N, Nakayama M et al. (2000) Fentanyl improves analgesia but prolongs the onset of axillary brachial plexus block by peripheral mechanism. Anesth Analg 91:384–387PubMedGoogle Scholar
  67. 67.
    O'Grady NP, Alexander M, Dellinger EP et al. (2002) Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 51:1–29Google Scholar
  68. 68.
    Ootaki C, Hayashi H, Amano M (2000) Ultrasound-guided infraclavicular brachial plexus block: an alternative technique to anatomical landmark-guided approaches. Reg Anesth Pain Med 25:600–604CrossRefPubMedGoogle Scholar
  69. 69.
    Partridge BL, Katz J, Benirschke K (1987) Functional anatomy of the brachial plexus sheath: implications for anesthesia. Anesthesiology 66:743–747PubMedGoogle Scholar
  70. 70.
    Picard PR, Tramer MR, McQuay HJ, Moore RA (1997) Analgesic efficacy of peripheral opioids (all except intra-articular): a qualitative systematic review of randomised controlled trials. Pain 72:309–318CrossRefPubMedGoogle Scholar
  71. 71.
    Pippa P, Cominelli E, Marinelli C, Aito S (1990) Brachial plexus block using the posterior approach. Eur J Anaesthesiol 7:411–420Google Scholar
  72. 72.
    Rawal N (2001) Analgesia for day-case surgery. Br J Anaesth 87:73–87CrossRefPubMedGoogle Scholar
  73. 73.
    Rawal N, Allvin R, Axelsson K et al. (2002) Patient-controlled regional analgesia (PCRA) at home: controlled comparison between bupivacaine and ropivacaine brachial plexus analgesia. Anesthesiology 96:1290–1296PubMedGoogle Scholar
  74. 74.
    Reuben SS, Reuben JP (2000) Brachial plexus anesthesia with verapamil and/or morphine. Anesth Analg 91:379–383PubMedGoogle Scholar
  75. 75.
    Rodriguez J, Barcena M, Alvarez J (1996) Axillary brachial plexus anesthesia: electrical versus cold saline stimulation. Anesth Analg 83:752–754PubMedGoogle Scholar
  76. 76.
    Rucci FS, Trafficante FG, Pippa P (1987) Fentanyl and bupivacaine mixture for extradural blockade in orthopaedic surgery: effects on haemodynamic responses and pain related to the use of thigh tourniquet. Eur J Anaesthesiol 4:167–174PubMedGoogle Scholar
  77. 77.
    Sandhu NS, Capan LM (2002) Ultrasound-guided infraclavicular brachial plexus block. Br J Anaesth 89:254–259CrossRefPubMedGoogle Scholar
  78. 78.
    Schroeder LE, Horlocker TT, Schroeder DR (1996) The efficacy of axillary block for surgical procedures about the elbow. Anesth Analg 83:747–751PubMedGoogle Scholar
  79. 79.
    Schulz-Stubner S (1996) Hypnose—eine nebenwirkungsfreie Alternative zur medikamentösen Sedierung bei Regionalanästhesien. Anaesthesist 45:965–969CrossRefPubMedGoogle Scholar
  80. 80.
    Schulz-Stubner S (2002) Clinical hypnosis instead of drug-based sedation for procedures under regional anesthesia. Reg Anesth Pain Med 27:622–623Google Scholar
  81. 81.
    Sia S, Lepri A (1999) Clonidine administered as an axillary block does not affect postoperative pain when given as the sole analgesic. Anesth Analg 88:1109–1112PubMedGoogle Scholar
  82. 82.
    Sims JK (1977) A modification of landmarks for infraclavicular approach to brachial plexus block. Anesth Analg 56:554–555PubMedGoogle Scholar
  83. 83.
    Singelyn FJ, Gouverneur JM, Robert A (1996) A minimum dose of clonidine added to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block. Anesth Analg 83:1046–1050PubMedGoogle Scholar
  84. 84.
    Thompson GE, Rorie DK (1983) Functional anatomy of the brachial plexus sheaths. Anesthesiology 59:117–122PubMedGoogle Scholar
  85. 85.
    Turkan H, Baykal B, Ozisik T (2002) Axillary brachial plexus blockade: an evaluation of three techniques. Mil Med 167:723–725PubMedGoogle Scholar
  86. 86.
    Urbanowicz Z (1996) Some features of the internal structure of the brachial plexus lateral cord in man. Ann Univ Mariae Curie Sklodowska [Med] 51:25–30Google Scholar
  87. 87.
    Urmey WF, Grossi P (2002) Percutaneous electrode guidance: a noninvasive technique for prelocation of peripheral nerves to facilitate peripheral plexus or nerve block. Reg Anesth Pain Med 27:261–267CrossRefPubMedGoogle Scholar
  88. 88.
    Vester-Andersen T, Broby-Johansen U, Bro-Rasmussen F (1986) Perivascular axillary block VI: the distribution of gelatine solution injected into the axillary neurovascular sheath of cadavers. Acta Anaesthesiol Scand 30:18–22PubMedGoogle Scholar
  89. 89.
    Walton JS, Folk JW, Friedman RJ, Dorman BH (2000) Complete brachial plexus palsy after total shoulder arthroplasty done with interscalene block anesthesia. Reg Anesth Pain Med 25:318–321PubMedGoogle Scholar
  90. 90.
    Wang SM, Peloquin C, Kain ZN (2001) The use of auricular acupuncture to reduce preoperative anxiety. Anesth Analg 93:1178–1180, table of contentsPubMedGoogle Scholar
  91. 91.
    Weber SC, Abrams JS, Nottage WM (2002) Complications associated with arthroscopic shoulder surgery. Arthroscopy 18:88–95CrossRefPubMedGoogle Scholar
  92. 92.
    Winnie AP (1970) Interscalene brachial plexus block. Anesth Analg 49:455–466PubMedGoogle Scholar
  93. 93.
    Winnie AP (1995) Does the transarterial technique of axillary block provide a higher success rate and a lower complication rate than a paresthesia technique? New evidence and old. Reg Anesth 20:482–485PubMedGoogle Scholar
  94. 94.
    Winnie AP, Collins VJ (1964) The subclavia perivascular technique of brachial plexus anesthesia. Anesthesiology 25:353–363Google Scholar
  95. 95.
    Yamamoto K, Nomura T, Shibata K, Ohmura S (1997) Failed axillary brachial plexus block techniques result in high plasma concentrations of mepivacaine. Reg Anesth 22:557–561PubMedGoogle Scholar
  96. 96.
    Yamamoto K, Tsubokawa T, Ohmura S, Kobayashi T (1999) The effects of arm position on central spread of local anesthetics and on quality of the block with axillary brachial plexus block. Reg Anesth Pain Med 24:36–42PubMedGoogle Scholar
  97. 97.
    Zipkin M, Backus WW, Scott B, Poppers PJ (1991) False aneurysm of the axillary artery following brachial plexus block. J Clin Anesth 3:143–145PubMedGoogle Scholar

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© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Department of AnesthesiaUniversity of Iowa Hospitals and ClinicsIowa CityUSA
  2. 2.Department of AnesthesiaUniversity of Iowa Hospitals and ClinicsIowa 52242USA

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