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Peripheral nerve blocks on the upper extremity

Technique of landmark-based and ultrasound-guided approaches

  • Regionalanästhesie
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Abstract

The German Society of Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI) established an expert panel to develop preliminary recommendations for the application of peripheral nerve blocks on the upper extremity. The present recommendations state in different variations how ultrasound and/or electrical nerve stimulation guided nerve blocks should be performed. The description of each procedure is rather a recommendation than a guideline. The anaesthesiologist should select the variation of block which provides the highest grade of safety according to his individual opportunities. The first section comprises recommendations regarding dosages of local anaesthetics, general indications and contraindications for peripheral nerve blocks and informations about complications. In the following sections most common blocks techniques on the upper extremity are described. 

Zusammenfassung

Eine Expertengruppe der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) hat eine Zusammenstellung zur Vorgehensweise peripherer Blockaden der oberen Extremität verfasst. Die vorliegenden Hinweise zur Durchführung peripherer Nervenblockaden sollen klinischen Anwendern einen Überblick über die heute übliche Praxis Landmarken-gestützter und Ultraschall-gesteuerter Verfahren geben. Die Anleitungen zu den einzelnen Blockaden beinhalten teilweise eindeutige Aussagen, denen im Sinne der Patientensicherheit Beachtung zu schenken ist. Rein beschreibende Ausführungen lassen dem Anwender die Möglichkeit, die Ausführung von Blockaden entsprechend einer anderen Variante zu modifizieren – insbesondere wenn die Abweichung von der vorliegenden Empfehlung der Sicherheit des Patienten und/oder der des durchführenden Arztes dient.

Zunächst werden allgemein gültige Aspekte bzw. Empfehlungen der peripheren Regionalanästhesie vorangestellt, wie Dosierung der Lokalanästhetika, Kontraindikationen und allgemeine Komplikationen. Bei der anschließenden Darstellung der einzelnen Blockaden wird daher nur noch auf spezifische Besonderheiten eingegangen. Die allgemeinen Erläuterungen sind entsprechend bei der Aufklärung, Indikationsstellung sowie bei der Durchführung der Blockaden zu berücksichtigen.

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Author information

Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Care Therapy, UKGM Giessen-Marburg, Location Marburg, Marburg, Germany

    T. Steinfeldt MD & H. Wulf

  2. Department of Anaesthesiology, Intensive Care Medicine and Pain Management, University Hospital Saarland, Homburg, Germany

    T. Volk

  3. Department of Anaesthesiology, Intensive Care- and Pain Medicine, Orthopaedic University Hospital Friedrichsheim, Frankfurt am Main, Germany

    P. Kessler & J. Souquet

  4. Department of Anaesthesiology and Intensive Care Medicine, University Hospital Karl-Gustav Carus, Dresden, Germany

    O. Vicent

  5. Department for Anaesthesiology, Intensive Care- and Pain Medicine, Diakonische Dienste Hannover gGmbH, Hannover, Germany

    A. Gottschalk

  6. Department for Anaesthesia and Intensive Care Therapy, Waldkrankenhaus “Rudolf Elle” GmbH, Eisenberg, Germany

    M. Lange

  7. Department for Anaesthesiology, Intensive Care Medicine, Pain Therapy and Palliative Medicine, HELIOS Klinikum Borna, HELIOS Klinikum Borna, Borna, Germany

    P. Schwartzkopf

  8. Department for Anaesthesia and Intensive Care Medicine, Klinikum Worms gGmbH, Worms, Germany

    E. Hüttemann

  9. Department for Anaesthesiology, Intensive Care Medicine and Pain Therapy, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany

    R. Tessmann & A. Marx

  10. Department for Anaesthesiology and Intensive Care Medicine, Diakonissenkrankenhaus, Flensburg, Germany

    D. Häger

  11. Department for Anaesthesiology and Surgical Intensive Care Medicine, St. Vincentius-Kliniken gAG Karlsruhe, Karlsruhe, Germany

    W. Nagel & J. Biscoping

  12. Department for Anaesthesiology and Intensive Care Medicine, County Hospital Neumarkt i. d. OPf., Neumarkt i. d. OPf., Germany

    U. Schwemmer

  13. Department of Anaesthesiology and Intensive Care Therapy, Philipps University Hospital, Philipps University Marburg, Baldingerstr., 35033, Marburg, Germany

    T. Steinfeldt MD

Authors
  1. T. Steinfeldt MD
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  2. T. Volk
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  3. P. Kessler
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  4. O. Vicent
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  5. H. Wulf
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  6. A. Gottschalk
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  7. M. Lange
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  8. P. Schwartzkopf
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  9. E. Hüttemann
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  10. R. Tessmann
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  11. A. Marx
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  12. J. Souquet
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  13. D. Häger
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  14. W. Nagel
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  15. J. Biscoping
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  16. U. Schwemmer
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Corresponding author

Correspondence to T. Steinfeldt MD.

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Conflict of interest

T. Steinfeldt, T. Volk, P. Kessler, O. Vicent, H. Wulf, A. Gottschalk, M. Lange, P. Schwartzkopf, E. Hüttemann, R. Tessmann, A. Marx, J. Souquet, D. Häger, W. Nagel, J. Biscoping and U. Schwemmer declare no conflict of interest.

Additional information

Jointly developed by the scientific group for regional anaesthesia and obstetrics and the scientific group for ultrasound in anaesthesia and intensive medicine. All authors are members of the German Society of Anaesthesiology and Intensive Care Medicine, Nürnberg, Germany (Infobox 1).

Presentations: The recommendations were presented at the Annual Regional Anaesthesia Symposium of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) in Dresden, Germany (November 8, 2014) and at the Annual Congress of the German Society of Anaesthesiology and Intensive Care Medicine in Duesseldorf, Germany (May 9, 2015).

Published in German: Steinfeldt T, Volk T, Kessler P et al (2015) Periphere Blockaden der oberen Extremität. Vorgehensweise Landmarken-gestützter und Ultraschall-gesteuerter Verfahren. Anästh Intensivmed 56:244–252

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Steinfeldt, T., Volk, T., Kessler, P. et al. Peripheral nerve blocks on the upper extremity. Anaesthesist 64, 846–854 (2015). https://doi.org/10.1007/s00101-015-0091-x

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  • DOI: https://doi.org/10.1007/s00101-015-0091-x

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