Pediatric Regional Anesthesia for the Upper Limb

Abstract

All major nerves supplying the upper limb originate from the brachial plexus. The brachial plexus arises from the ventral rami of C5 to T1 (with occasional contributions from C4 and T2). It originates in the neck, passes laterally and inferiorly over the first rib, and enters the axilla. The brachial plexus is divided in segments of roots, trunks, divisions, cords, and terminal nerves. The segments and individual nerves can be anesthetized proximally or distally using various single shot or catheter techniques via landmark, ultrasound use, and/or nerve stimulator. In pediatrics, upper limb peripheral nerve blocks are primarily performed under general anesthesia but can be done under sedation. Upper limb nerve blocks are performed, most commonly, in pediatrics for orthopedic surgery, plastic surgery, and chronic pain, but other less common indications may exist. In this chapter, we review four of the most commonly, performed pediatric upper limb nerve blocks.