[Diaphragmatic excursion after inter-sternocleidomastoid block depending on the site of the injection]

Brachial plexus block

PURPOSE OF REVIEW

In recent years there has been a renewed interest in regional anesthesia, particularly peripheral nerve blockade, in order not only to improve the patient's well being, but also to meet the requirements of modern orthopedic surgery. These requirements include appropriate conditions to perform early and efficient rehabilitation.

RECENT FINDINGS

The upper extremity is well designed for the practice of the perineural catheter technique, since we have three main approaches, interscalene, infraclavicular and axillary, which allow all territories involved in specific surgical procedures to be blocked with only one shot or catheter. Recent developments have focused on modification of traditional technical approaches, improving the safety of the procedure, finding a more efficient way to administer the local anesthetic through the perineural catheter, and examining new indications and modes of performing regional anesthesia.

SUMMARY

Early rehabilitation is currently a key point for the success of orthopedic surgery. The rapid development of peripheral nerve blockade gives the anesthesiologist the means to face this new challenge.

Severe respiratory failure after infraclavicular block with 0.75% ropivacaine: a case report

Upper extremity surgery is usually performed with an axillary block. There is a risk of pneumothorax and phrenic nerve block when interscalene or supraclavicular block are used in day case surgery, or in patients with chronic obstructive pulmonary disease. The infraclavicular block is a simple, reliable, and easy to learn method to block the brachial plexus. No clinically relevant respiratory effects have been reported with infraclavicular block. Nonetheless, we report a case of a chronic obstructive pulmonary disease patient who developed severe respiratory failure requiring tracheal intubation after an infraclavicular block.

Regional anaesthesia for orthopaedic surgery

Recently, there has been considerable interest in regional anaesthetic techniques, particularly in peripheral nerve blockade, for orthopaedic limb surgery. Many traditional nerve-block techniques have been significantly modified to improve their role in both in-patient and out-patient surgery. The introduction of long-acting local anaesthetic with a better safety profile as well as better equipment for continuous nerve blockade has further increased the use of such techniques in the provision of postoperative analgesia. The recent developments described in this review are likely to result in wider use of these techniques in years to come.