Brachial Plexus (Introduction and Anatomy)

Abstract

The classical blocks of the brachial plexus using Hirschel’s [1] (axillary approach) and Kulenkampff’s [2] (supraclavicular block) anesthesia have been continuously developed and supplemented with additional access routes. As representative techniques for a multitude of clinical procedures for plexus anesthesia, the axillary perivascular block [3–5], subclavian perivascular block using the Winnie and Collins technique [6], Winnie’s interscalene block [5, 7], and Raj’s infraclavicular approach [8] may be mentioned. All of the blocks of the brachial plexus are based on the concept that the nerve plexus lies within a perivascular and perineural space in its course from the transverse processes to the axilla. Like the epidural space, this space limits the spread of the local anesthetic and conducts it to the various trunks and roots. Within the connective-tissue sheath, the concentration and volume of the local anesthetic used determine the extent of the block’s spread.