Brachial plexus anaesthesia for upper limb surgery: A review of eight years’ experience

Abstract

1248 supraclavicular brachial plexus blocks and 665 axillary plexus blocks were administered to 1913 patients undergoing upper limb surgery. Plexus block alone was successful in 83.5%. In a further 11.4 % of cases, adequate anaesthesia was obtained following augmentation by other regional or local techniques. This resulted in an overall success rate of 94.9 % and genera1 auaesthesia was required in only 5.1%. The two percutaneous approaches to the brachial plexus did not differ in their success-rates but clinically apparent pneumothorax occurred in 0.8 % of supraclavicular blocks. Brachial plexus block anaesthesia is recommended as a safe and satisfactory alternative to genera1 anaesthesia for upper limb surgery. Both axillary and supraclavicular approaches to percutaneous brachial plexus block anaesthesia were received enthusiastically following their introduction early in this century as preferable alternatives to general anaesthesia (Kulenkampff, 1911). Subsequently, interest in the methods declined as technical and pharmacologi-cal advances led to safer general anaesthesia. Now few British anaesthetists, and even fewer surgeons, utilise these techniques and therefore we wish to report our experience. The methods used (Eriksson, 1979) are highly successful and have a low incidence of significant complications. They can be rapidly learnt by surgeons in training and require no specialised equipment. TABLE 1 Contra-indications to brachial plexus block anaestbesia 1. Surgery to more than one limb 2. Anxious or unto-operative patient 3. Previous brachial plexus surgery or trauma 4. Allergy to local anaesthetic drugs 5. Obesity, especially when combined with a short neck 6. Congenital anomalies of the neck and shoulde