BPB : Brachial Plexus Block

Brachial Plexus Block (BPB) is a procedure performed by an Anesthesiologist in order to deliver regional anesthesia to the targeted area. Sometimes, it serves as an alternative or as an adjunct to general anesthesia for surgery of the upper extremity. 

This procedure involves the injection of local anesthetic agents in close proximity to the brachial plexus, temporarily blocking the sensation and ability to move the upper extremity. 

Which Ultrasound is the best for BPB?

High-frequency Ultrasound Scanner with linear transducer (10 to 14MHz ) is needed for BPB, This is why the Mini Linear Handheld Wi-Fi Ultrasound Scanner ML1 is recommended to our anesthesiologist clients.

The portable Ultrasound scanners guidance allows for visualization of the spread of the local anesthetic and additional injections around the brachial plexus if needed to ensure an adequate spread of local anesthetic, improving block success.

The brachial plexus can be blocked at multiple sites for varying effect.It is commonly achieved via an interscalene, supraclavicular, or axillary approach.

*The Interscalene Block: is indicated for procedures on the shoulder and proximal humerus as well as the lateral two-thirds of the clavicle. The interscalene block can also be utilized for surgery of the arm or forearm; however, the higher incidence of an incomplete blockade of the inferior trunk with this technique may provide inadequate analgesia in the ulnar distribution. The patient’s positioning and comfort, the surgeon’s preferences, and the duration of surgery may necessitate the coadministration of a general anesthetic. An interscalene catheter may be inserted for prolonged postoperative analgesia. 

*The supraclavicular Block: is one of several techniques used to anesthetize the brachial plexus. The block is performed at the level of the brachial plexus trunks where almost the entire sensory, motor and sympathetic innervation of the upper extremity is carried in just three nerve structures confined to a very small surface area. Consequently, this technique typically provides a predictable, dense block with rapid onset. 

*The axillary approach: analgesia or surgical anesthesia of the upper limb from mid humerus to the fingertips. This block also spares the intercostobrachial nerve, although it is blocked easily within the same window.

After injecting a small amount of 1% lidocaine to anaesthetise the skin, insert the short bevel needle along the longitudinal axis of the ultrasound probe (in-plane needle approach). Ensure the needle is kept parallel to this axis at all times to improve visualisation of the needle tip. The in-plane approach is strongly recommended for this block; the needle tip and shaft should be continuously visualised in real time to avoid inadvertent pleural puncture.

To sum up, Ultrasound-guided brachial plexus blocks can provide dense analgesia and anesthesia to the upper extremity from the shoulder to the fingers depending on the indication and approach utilized. The use of ultrasound has made these blocks more accessible and safer to perform.

References: Brachial Plexus Block, Interscalene Brachial Plexus Block,    Supraclavicular BPB,  Brachial Plexus Block techniques,