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Upper Extremity Regional Anesthesia
- 1. BFSA Slide by Brian F S Allen BFSA BFSA Upper Extremity Regional Anesthesia Brian Allen 06/2014
- 2. BFSA Slide by Brian F S Allen BFSA BFSA Scalp* (U,P){2} Interscalene (S,L){2} Transgluteal Sciatic (L,P){4,6} Paravertebral (U,L){4,6} Thoracic Epidural (U,L){4,6} Lumbar Plexus† (L){4,6} TAP (S){4} Superficial Cervical Plexus* (S){2} Axillary* (S,A){2} Infraclavicular (S,A){4} Supraclavicular (S){2} Lumbar Epidural (U,L){4,6} Infragluteal Sciatic (S,L,P){4,6} Ankle* (S){2} Lat Fem Cut* (S){2,4} Popliteal Sciatic (S,U,L){4} Femoral (S){2,4} Obturator* (S){4} Saphenous (S,P){4} HEENT*{2} Wrist* (S){2} Legend: * = Only Single Shot Bold = May Place Catheter Underline = uncommonly done † = Nerve Stimulator always used Positioning ( ): S = Supine U = Sitting Up P = Prone L = Lateral Decubitus or Simms A = Arm Over Head Needle Length { in inches } Common Regional and Neuraxial Blocks Suprascapular* (U){2,4} Spinal (U,L){3.5,6}
- 3. BFSA Slide by Brian F S Allen BFSA BFSA
- 4. BFSA Slide by Brian F S Allen BFSA BFSA RootsTrunks Divisions Cords Terminal Nerves
- 5. BFSA Slide by Brian F S Allen BFSA BFSA
- 6. BFSA Slide by Brian F S Allen BFSA BFSA Interscalene Supraclavicular Infraclavicular Axillary
- 7. BFSA Slide by Brian F S Allen BFSA BFSA
- 8. BFSA Slide by Brian F S Allen BFSA BFSA Upper Extremity Dermatomes
- 9. BFSA Slide by Brian F S Allen BFSA BFSA Upper Extremity Innervation
- 10. BFSA Slide by Brian F S Allen BFSA BFSA Upper Extremity Osteotomes
- 11. BFSA Slide by Brian F S Allen BFSA BFSA Interscalene Supraclavicular Infraclavicular Axillary
- 12. BFSA Slide by Brian F S Allen BFSA BFSA Interscalene Supraclavicular Infraclavicular Axillary
- 13. BFSA Slide by Brian F S Allen BFSA BFSA Interscalene Supraclavicular Infraclavicular Axillary Shoulder Arm, Hand
- 14. BFSA Slide by Brian F S Allen BFSA BFSA Interscalene Supraclavicular Infraclavicular Axillary Shoulder Elbow? Arm, Hand
- 15. BFSA Slide by Brian F S Allen BFSA BFSA
- 16. BFSA Slide by Brian F S Allen BFSA BFSA ISB SCB ICB AXB
- 17. BFSA Slide by Brian F S Allen BFSA BFSA ISB Surface Anatomy Image: Jaci Berkopec
- 18. BFSA Slide by Brian F S Allen BFSA BFSA ISB Surface Anatomy Sterno- cleido- mastoid Image: Jaci Berkopec
- 19. BFSA Slide by Brian F S Allen BFSA BFSA ISB Surface Anatomy Anterior Scalene Middle Scalene Image: Jaci Berkopec
- 20. BFSA Slide by Brian F S Allen BFSA BFSA ISB Surface Anatomy Brachial Plexus Image: Jaci Berkopec
- 21. BFSA Slide by Brian F S Allen BFSA BFSA ISB Surface Anatomy Sterno- cleido- mastoid Brachial Plexus Image: Jaci Berkopec Anterior Scalene Middle Scalene
- 22. BFSA Slide by Brian F S Allen BFSA BFSA ISB Surface Anatomy Image: Jaci Berkopec Ultrasound Probe
- 23. BFSA Slide by Brian F S Allen BFSA BFSA Interscalene AnteriorPosterior Image: Brian Allen
- 24. BFSA Slide by Brian F S Allen BFSA BFSA Interscalene Anterior ScaleneMiddle Scalene SCM AnteriorPosterior Image: Brian Allen
- 25. BFSA Slide by Brian F S Allen BFSA BFSA Interscalene Anterior ScaleneMiddle Scalene SCM AnteriorPosterior Interscalene Groove Image: Brian Allen
- 26. BFSA Slide by Brian F S Allen BFSA BFSA Interscalene Anterior ScaleneMiddle Scalene SCM C5 C7 C6 C6 AnteriorPosterior Image: Brian Allen
- 27. BFSA Slide by Brian F S Allen BFSA BFSA Interscalene C5 C7 C6 C6 “Traffic Light” AnteriorPosterior Image: Brian Allen
- 28. BFSA Slide by Brian F S Allen BFSA BFSA Interscalene “Traffic Light” AnteriorPosterior Image: Brian Allen
- 29. BFSA Slide by Brian F S Allen BFSA BFSA Interscalene Side Effects, Complications Common • Phrenic Nerve Block (100%) • Horner’s Syndrome (25- 50%) • Hoarseness (10-20%) Rare • Pneumothorax • Cough • Bronchospasm Contraindications • Severe Respiratory Disease
- 30. BFSA Slide by Brian F S Allen BFSA BFSA Interscalene Neurostimulation, Block Success Neurostimulation • Expected: Deltoid, Biceps, Pec • Unfavorable: – Trapezius (CN XI) – too posterior – Diaphragm (Phrenic) – too anterior Block Success • Money Sign • Deltoid Weakness
- 31. BFSA Slide by Brian F S Allen BFSA BFSA ISB SCB ICB AXB
- 32. BFSA Slide by Brian F S Allen BFSA BFSA SCB Surface Anatomy
- 33. BFSA Slide by Brian F S Allen BFSA BFSA SCB Surface Anatomy Clavicle Axillary Artery Subclavian Artery
- 34. BFSA Slide by Brian F S Allen BFSA BFSA SCB Surface Anatomy Brachial Plexus MC PC LC C5 C6 C7 C8 T1
- 35. BFSA Slide by Brian F S Allen BFSA BFSA SCB Surface Anatomy Clavicle Axillary Artery Subclavian Artery MC PC LC Ultrasound Probe
- 36. BFSA Slide by Brian F S Allen BFSA BFSA Image: Brian Allen Supraclavicular Supero- Lateral Infero- Medial
- 37. BFSA Slide by Brian F S Allen BFSA BFSA Supraclavicular Image: Brian Allen Supero- Lateral Infero- Medial
- 38. BFSA Slide by Brian F S Allen BFSA BFSA SCA First Rib Pleura Pleura Supraclavicular Image: Brian Allen Supero- Lateral Infero- Medial
- 39. BFSA Slide by Brian F S Allen BFSA BFSA SCA Brachial Plexus Supraclavicular Image: Brian Allen Supero- Lateral Infero- Medial
- 40. BFSA Slide by Brian F S Allen BFSA BFSA SCA Brachial Plexus Supraclavicular Image: Brian Allen Infero- Medial
- 41. BFSA Slide by Brian F S Allen BFSA BFSA “Corner Pocket” Supraclavicular Image: Brian Allen Supero- Lateral Infero- Medial
- 42. BFSA Slide by Brian F S Allen BFSA BFSA Supraclavicular Side Effects, Complications Common • Phrenic Nerve Block (<50%) Rare • Pneumothorax • Horner’s Syndrome Contraindications • Severe Respiratory Disease?
- 43. BFSA Slide by Brian F S Allen BFSA BFSA Neurostimulation • Expected: Distal (Hand) • Unfavorable: Proximal (Deltoid, Biceps) Block Success • Push – Triceps, Elbow Extend • Pull – Biceps, Elbow Flex • Pinch – Pinch Thenar • Pinch – Pinch Hypothenar Supraclavicular Neurostimulation, Block Success
- 44. BFSA Slide by Brian F S Allen BFSA BFSA ISB SCB ICB AXB
- 45. BFSA Slide by Brian F S Allen BFSA BFSA ICB Surface Anatomy
- 46. BFSA Slide by Brian F S Allen BFSA BFSA ICB Surface Anatomy Clavicle Axillary Artery Subclavian Artery
- 47. BFSA Slide by Brian F S Allen BFSA BFSA ICB Surface Anatomy Clavicle Axillary Artery Subclavian Artery Pectoralis Minor
- 48. BFSA Slide by Brian F S Allen BFSA BFSA ICB Surface Anatomy Clavicle Axillary Artery Subclavian Artery Pectoralis Major
- 49. BFSA Slide by Brian F S Allen BFSA BFSA ICB Surface Anatomy Brachial Plexus MC PC LC C5 C6 C7 C8 T1 Pectoralis Major
- 50. BFSA Slide by Brian F S Allen BFSA BFSA ICB Surface Anatomy Brachial Plexus MC PC LC C5 C6 C7 C8 T1 Ultrasound Probe
- 51. BFSA Slide by Brian F S Allen BFSA BFSA Infraclavicular SuperiorInferior Image: Brian Allen
- 52. BFSA Slide by Brian F S Allen BFSA BFSA Infraclavicular Pectoralis Major Pectoralis Minor AA SuperiorInferior Image: Brian Allen
- 53. BFSA Slide by Brian F S Allen BFSA BFSA Infraclavicular AA SuperiorInferior Medial Cord Posterior Cord Lateral Cord Image: Brian Allen
- 54. BFSA Slide by Brian F S Allen BFSA BFSA Infraclavicular
- 55. BFSA Slide by Brian F S Allen BFSA BFSA Infraclavicular AA Inferior Superior Image: Brian Allen
- 56. BFSA Slide by Brian F S Allen BFSA BFSA Infraclavicular Ideal “U” Spread Inferior Superior Image: Brian Allen
- 57. BFSA Slide by Brian F S Allen BFSA BFSA Neurostimulation • Expected: Distal (Hand) • Unfavorable: Proximal (Deltoid, Biceps) Block Success (4 P’s) • Push – Triceps, Elbow Extend • Pull – Biceps, Elbow Flex • Pinch – Pinch Thenar • Pinch – Pinch Hypothenar Infraclavicular Neurostimulation, Block Success
- 58. BFSA Slide by Brian F S Allen BFSA BFSA ISB SCB ICB AXB
- 59. BFSA Slide by Brian F S Allen BFSA BFSA AXB Surface Anatomy Image: David Shankbone
- 60. BFSA Slide by Brian F S Allen BFSA BFSA AXB Surface Anatomy Image: David Shankbone Deltoid Triceps
- 61. BFSA Slide by Brian F S Allen BFSA BFSA AXB Surface Anatomy Image: David Shankbone Pectoralis Major Biceps
- 62. BFSA Slide by Brian F S Allen BFSA BFSA AXB Surface Anatomy Image: David Shankbone Coracobrachialis
- 63. BFSA Slide by Brian F S Allen BFSA BFSA AXB Surface Anatomy Image: David Shankbone Axillary Artery Ultrasound Probe
- 64. BFSA Slide by Brian F S Allen BFSA BFSA AXB Surface Anatomy Image: David Shankbone
- 65. BFSA Slide by Brian F S Allen BFSA BFSA AXB Surface Anatomy Image: David Shankbone Mc M R U AA LC MC
- 66. BFSA Slide by Brian F S Allen BFSA BFSA Axillary Supero-Lateral Infero-Medial Image: Brian Allen
- 67. BFSA Slide by Brian F S Allen BFSA BFSA Axillary Supero-Lateral Infero-Medial M Mc U R Image: Brian Allen
- 68. BFSA Slide by Brian F S Allen BFSA BFSA Axillary Supero-Lateral Infero-Medial M Mc U R Median Musculocutaneous Radial Ulnar Image: Brian Allen
- 69. BFSA Slide by Brian F S Allen BFSA BFSA Axillary Supero-Lateral Infero-Medial M Mc U R Image: FutureNJGov
- 70. BFSA Slide by Brian F S Allen BFSA BFSA Axillary Supero-Lateral Infero-Medial M Mc U R Image: Brian Allen
- 71. BFSA Slide by Brian F S Allen BFSA BFSA Axillary Supero-Lateral Infero-Medial ? ? AA ? Image: Brian Allen
- 72. BFSA Slide by Brian F S Allen BFSA BFSA Axillary Supero-Lateral Infero-Medial AA Ideal Spread
- 73. BFSA Slide by Brian F S Allen BFSA BFSA Axillary Supero-Lateral Infero-Medial M Mc U R#1
- 74. BFSA Slide by Brian F S Allen BFSA BFSA Axillary Supero-Lateral Infero-Medial M Mc U R#1 #2
- 75. BFSA Slide by Brian F S Allen BFSA BFSA Axillary Supero-Lateral Infero-Medial M Mc U R#1 #2 #3
- 76. BFSA Slide by Brian F S Allen BFSA BFSA Axillary Supero-Lateral Infero-Medial M M U R#1 #2 #3 #4
- 77. BFSA Slide by Brian F S Allen BFSA BFSA Neurostimulation • Expected: Musculocutaneous, Radial, Median, Ulnar Block Success (4 P’s) • Push – Triceps, Elbow Extend • Pull – Biceps, Elbow Flex • Pinch – Pinch Thenar • Pinch – Pinch Hypothenar Axillary Neurostimulation, Block Success
- 78. BFSA Slide by Brian F S Allen BFSA BFSA Supero-Lateral Infero-Medial M Mc U R AA Musculocutaneous Ulnar Radial Median
- 79. BFSA Slide by Brian F S Allen BFSA BFSA Brachial Plexus Effect Comparisons Axillary MuscluocutaneousInfraclavicularSupraclavicularInterscalene
- 80. BFSA Slide by Brian F S Allen BFSA BFSA Brachial Plexus Effect Comparisons MuscluocutaneousAxillaryIntercostobrachial Superficial Cervical Plexus
- 81. BFSA Slide by Brian F S Allen BFSA BFSA