Introduction
The brachial plexus anaesthesia is a method of regional anaesthesia under which operations in the arm area are possible. The procedure is relatively simple to perform and has few complications. In addition to use during surgery, brachial plexus anesthesia can also be used for chronic pain.
Anatomy of the brachial plexus
The brachial plexus is a complex plexus consisting of the spinal nerves C5 to Th1, which supplies nerves mainly to the arms and hands, but also to the shoulder region. After exiting the spinal canal, it runs between two muscles in the neck, the anterior and medial scalenus muscles, which form the so-called “scalenus gap”. As it continues, it then runs under the collarbone in the direction of the arm. On its way, the brachial plexus is accompanied by blood vessels. This complete strand of nerves and blood vessels is surrounded by connective tissue plates and divided into different compartments.
Performance of anesthesia
In brachial plexus anesthesia, a local anesthetic is injected with a hypodermic needle into one of the compartments and then distributed along the plexus. Depending on which nerves or which parts of the arm are to be anaesthetized, the anaesthetic is injected at different points. A nerve stimulator and/or an ultrasound device are always helpful in locating the nerve plexus.
The nerve stimulator is coupled to the injection needle and indicates the right place for anaesthesia by sending current pulses to the muscles supplied by the nerve. With the help of the ultrasound device it is possible to visualize the nerves themselves, which look something like a cloud or absorbent cotton. Or one can orientate oneself to lead structures such as blood vessels that run in a similar way.
Indication
The local anesthetic, which is injected near the brachial plexus, inhibits the transmission of the action potential along the nerve by acting on the respective ion channels. As a result, information such as pain or pressure is not transmitted. The indication for a nerve blockage is mainly in the surgical area, in order to avoid pain during an operation on the arm.
This means that painkillers can be saved during the subsequent anaesthesia and after the operation, so that the patient develops fewer side effects of the painkillers and has less pain overall. An operation on the arm can also be performed without anesthesia, since the arm is anesthetized in every respect. This procedure can also be performed on elderly or seriously ill people who cannot be given a general anaesthetic.
Plexus brachialis anesthesia can be used, for example, to correct a dislocated shoulder (shoulder dislocation) so that the pain can be endured and the correction can take place while the patient is conscious. Another operation where such a procedure can be used is, for example, a distal radius fracture. In addition, a nerve blockage of the brachial plexus can reduce the pain in chronic pain sufferers. In general, the local anesthetic can be administered once or can be re-injected several times as needed using an indwelling plastic catheter, which can be fixed near the plexus for a certain period of time.