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Upper Limb Block

Overview

• The entire upper limb (shoulder → hand) is supplied by the Brachial plexus (C5–T1).
• Regional techniques are chosen according to:
  • Surgical field & tourniquet site
  • Need for diaphragm-sparing (respiratory comorbidity, obesity, pregnancy)
  • Post-operative analgesia duration (single-shot vs catheter)
  • Available imaging (ultrasound is standard of care)

Brachial Plexus

Level	Components	Main relations & landmarks	Key motor/sensory targets
Roots (ventral rami)	C5–T1 (± C4, T2 variants)	Emerge between anterior & middle scalene muscles in the posterior cervical triangle; run with the subclavian artery	Segmental branches: dorsal scapular (C5), long thoracic (C5–7), to scalene & longus colli
Trunks	Superior (C5-6), Middle (C7), Inferior (C8-T1)	Lie superior & posterior to the subclavian artery at the lateral border of the scalene muscles, directly above the first rib	Suprascapular & nerve to subclavius (from superior trunk)
Divisions	Each trunk splits into anterior & posterior divisions posterior to the clavicle	Pass deep to the clavicle and pectoralis minor with the second part of the axillary artery	No named branches
Cords	Fusion of divisions around the axillary artery in the axilla—lateral, posterior, medial (named by position to artery)	Deep to pectoralis minor, envelop the axillary artery	Lateral & medial pectoral, thoracodorsal, subscapulars, medial cutaneous nerves of arm/forearm
Terminal branches	Musculocutaneous (C5-7), Axillary (C5-6), Radial (C5-T1), Median (C5-T1), Ulnar (C8-T1)	Exit axilla at the inferior border of teres major & through the cubital fossa/arm	Motor & cutaneous supply to the entire upper limb except trapezius (cranial XI) & small medial upper-arm area (T2 intercostobrachial)

• Summary only; many smaller muscular & cutaneous branches arise proximally.

Organisational Mnemonics

• “Randy Travis Drinks Cold Beer” → Roots → Trunks → Divisions → Cords → Branches.

Clinical Pearls (anaesthetic relevance)

• Block approach aligns with levels: interscalene (roots/trunks), supraclavicular (trunks/divisions), infraclavicular (cords), axillary (terminal branches).
• Phrenic nerve risk highest with interscalene block (C3-5 proximity).
• Vascular neighbours: Subclavian/axillary artery is the constant landmark; cords wrap around it—posterior cord posterior, etc.
• Common injury sites: Erb’s point (upper trunk traction → C5-6 palsy); Klumpke (lower trunk traction); posterior cord compression (crutch palsy).

Different Blocks

Approach (US-guided)	Plexus level	Usual LA volume	Typical operations	Tourniquet cover	Specific complications (incidence)	Key caveats	Landmark (US probe position)	Needle technique	Motor-/sensory nerve-stim end-point
Interscalene (ISB)	Roots C5–C7	10–15 mL	Shoulder arthroplasty, proximal humerus fixation	Poor (upper arm)	Phrenic-nerve palsy (80–100 %), Horner’s (~20 %), RLN block (~10 %)	Avoid in severe COPD / contralat. hemidiaphragm palsy	Linear probe transverse at C6 (cricoid) over interscalene groove between anterior & middle scalene	In-plane lateral-to-medial; inject around visible root cluster	Deltoid / biceps twitch < 0.5 mA (or no twitch with pure US)
Supraclavicular (SCB)	Trunks / divisions	15–25 mL	Arm, elbow, radial-forearm	Excellent	Pneumothorax (0–0.7 %), Horner’s (~30 %), vascular puncture (~3 %)	Pleural proximity ↓ with US	Probe parallel to clavicle, medial to mid-clavicle, plexus “grapes” posterolateral to subclavian artery	In-plane lateral-to-medial; circumferential spread around trunks	Finger / wrist flex-ext twitch < 0.5 mA
Infraclavicular (ICB)	Cords	20–30 mL	Elbow, forearm, hand	Excellent	Axillary/subclavian vessel puncture (4–10 %), pneumothorax (<0.2 %)	Deeper; heed anticoagulation	Probe parasagittal below clavicle, medial to coracoid; cords around axillary artery/vein	In-plane cephalad-to-caudad; stalk needle into posterior cord first	Hand extension/supination or biceps twitch < 0.5 mA
Axillary	Terminal branches	20–30 mL	Hand, wrist	Good	Incomplete block (missed MCN) (5–20 %), vascular puncture (2–9 %)	Block musculocutaneous separately	Probe high axilla, visualize axillary artery with radial, median, ulnar around; MCN between coraco- & biceps	Multiple in-plane injections around each nerve; MCN blocked separately in coracobrachialis	Individual nerve twitches: thumb flex (median), 5th finger flex (ulnar), wrist/finger ext (radial), biceps (MCN) < 0.5 mA
Distal single-nerve (median, ulnar, radial, MCN)	Individual nerves	3–5 mL	Wrist / hand	None	Incomplete sensory block (~2 %), transient neuritis (<0.1 %)	Preserves proximal motor	Probe over target nerve at elbow/forearm	In-plane or out-of-plane; inject sheath	Appropriate distal motor response (e.g. thumb opposition for median) < 0.5 mA
IVRA (Bier)	Intravenous	0.5 % Prilocaine 3 mg kg⁻¹ (≤ 400 mg)	Short forearm / hand (< 60 min)	Tourniquet only	Tourniquet pain (~20 %), systemic toxicity if cuff premature (<0.1 %)	≥ 30 min cuff; no adrenaline	IV cannula dorsum of hand; double-cuff tourniquet upper arm	Exsanguination → inject LA IV under cuff	Not applicable–nerve stim not used

Phrenic Nerve Sparing Blocks

• When a patient’s respiratory reserve is limited, replacing ISB with either a superior trunk block or a combined suprascapular + axillary block preserves shoulder analgesia yet dramatically lowers the risk of diaphragmatic dysfunction.
• STB is a single-needle, fast option that mimics ISB onset and duration; the dual-nerve strategy is slightly more time-consuming but virtually eliminates phrenic involvement.

Why Phrenic-sparing Blocks Matter

• A conventional interscalene brachial plexus block (ISB) anaesthetises the C5–C7 roots that lie <2 mm from the phrenic nerve; even with ultrasound and low volumes, ≈70–100 % of patients develop hemidiaphragmatic paresis, cutting FVC by 20-30 %. In healthy people that is tolerated, but in COPD, obesity, pregnancy, severe asthma or contralateral lung pathology it can precipitate hypoxaemia or hypercapnia.

Phrenic-sparing Alternatives for Shoulder Surgery

Block	Technical note	Analgesic efficacy vs ISB	Incidence of hemi-diaphragmatic paresis
Superior trunk block (STB)	5–10 mL LA deposited around the fused C5-C6 trunk just above the subclavian artery	RCTs & 2023 meta-analysis: equal pain scores, opioid use and PACU discharge times	0–15 % (≈ 80 % relative risk reduction)
Suprascapular + axillary nerve block (SSNB + ANB)	8–10 mL around suprascapular nerve in suprascapular or supraclavicular fossa plus 5–8 mL around axillary nerve in the quadrilateral space	Large RCTs 2020–2024 show non-inferior 24 h pain and opioid consumption; sometimes need supplemental LA to skin portals	< 5 %; often zero when ultrasound-guided

Mechanism of Diaphragm Sparing

• Both techniques target sensory supply to the glenohumeral joint distal to the phrenic nerve’s course.
• The superior trunk injection sits caudal-posterior to the nerve, limiting cephalad spread, while the separate SSNB + ANB approach omits the root/trunk region entirely. Hence the phrenic nerve usually remains outside the LA field.

General Complications Common to all Upper-limb Blocks

• Local anaesthetic systemic toxicity (LAST)
• Infection (skin / deep tissue)
• Nerve injury (transient or permanent)
• Vascular injury or haematoma
• Block failure
• Anaphylaxis

Tourniquet Pain

Pathophysiology

• Ischaemia & nerve fibre imbalance–prolonged cuff inflation produces distal tissue ischaemia. Unmyelinated C-fibres (slow, dull pain) become progressively activated while myelinated A-δ fibres (fast pain/pressure) are blocked by local anaesthetic; loss of A-δ–mediated “gate control” unmasks C-fibre discharge.
• Metabolic mediators–local acidosis, potassium and bradykinin sensitise nociceptors.
• Sympathetic contribution–afferent sympathetic fibres may transmit pain and drive tourniquet-induced hypertension.

Typical Onset & Course

Limb	Mean onset after inflation	Haemodynamic correlate
Upper	25–35 min	HR & MAP rise ≈ 15 % from baseline
Lower	35–45 min	Similar but more gradual

• Pain intensifies until cuff deflation and can outlast block sensory level.

Prevention & Management Options

Strategy (level of evidence)	Key details	Outcome benefit
Double-cuff technique (expert opinion)	Inflate distal cuff after 30 min, deflate proximal cuff	Delays pain by additional 15–20 min; standard in IV
Lower cuff pressure / limb exsanguination (observational)	Pressure 100 mmHg above systolic (upper limb) or < 250 mmHg	↓ incidence & intensity of pain; fewer haemodynamic sur
Adjuvants to IVRA
1.	Dexmedetomidine 0.25–0.5 µg kg⁻¹ added to lidocaine (RCT 2023)	Prolongs tourniquet tolerance by ≈ 18 min; ↓ intra-op opioids
2.	Ketamine 0.3 mg kg⁻¹ IV or 0.1 mg kg⁻¹ in IVRA (RCTs 2001–2019)	Prevents tourniquet-induced hypertension; pain scores
3.	Clonidine 1 µg kg⁻¹ in IVRA (meta-analysis 2022)	Extends analgesia 12 min
Intercostobrachial (T2) field block (2 RCTs 2022–2023 ± small RCTs 2018; cadaver / observational anatomy studies)	1–3 mL 1–1.5 % lidocaine (or 0.25 % ropivacaine) infiltrated subcutaneously along the posterior axillary fold or ultrasound-guided injection between serratus anterior & intercostal muscles at 2nd rib to envelop the intercostobrachial nerve. • Performed after brachial-plexus block, before tourniquet inflation. • Pure sensory nerve → no motor impairement.	• Pain-score reduction: mean NRS ↓ ~3–4 points vs control and 60 % fall in opioid rescue use; onset of discomfort delayed ≈15–20 min during 200–250 mmHg cuffs • No haemodynamic surges in ≥90 min tourniquet times (small RCT). • A second RCT with dense supraclavicular blocks found no statistically significant advantage, suggesting benefit may be greatest when the proximal block does not spread to T2 or when ≥60 min inflation is anticipated.
Systemic analgesia (randomised data)	Fentanyl 1 µg kg⁻¹ or remifentanil 0.05 µg kg⁻¹ min⁻¹ infusion started at 20 min	Blunts HR/MAP rise; patient
Rescue during block	Incremental propofol or midazolam + short-acting opioid; if pain uncontrolled after 60 min consider cuff deflation–re-inflation (“deflate-reperfuse-re-inflate”) or convert to GA	Prevents catecholamine surge an
Post-deflation care	Observe ≥ 20 min for rebound hypotension, LAST from IVRA	Early mobilisation once sensat

Adjuvants & Catheters

Adjuvant	Dose (perineural)	Benefit	Caveats
Dexamethasone	4 mg	↑ block duration 6–10 h; ↓ PONV	Hyperglycaemia, avoid infection focus
Dexmedetomidine	25–50 µg	↑ duration ≈ dexamethasone, faster onset	Bradycardia, hypotension
Combined Dex-Dex	4 mg + 25 µg	No clear superiority over dexamethasone alone	Off-label; obtain consent
Magnesium sulphate	150 mg	Modest prolongation	Limited evidence (SAJAA 2022)

• Continuous catheters (interscalene, costoclavicular, infraclavicular) enable ≥ 48 h analgesia at home (0.2 % ropivacaine 5–8 mL h⁻¹); provide rescue bolus protocol and emergency contact.

Complications & Mitigation

Complication	Incidence	Prevention / Management
Haemidiaphragmatic paralysis	High with ISB	Use STB/CCB; limit LA volume ≤ 15 mL
Pneumothorax (SCB)	< 1 % with US	Visualise pleura; lateral probe orientation
LAST	1: 10 000	Dose calculation, incremental injection, aspiration, US, lipid kit ready
Nerve injury	< 0.2 % persistent	Avoid high opening pressure (> 15 psi), no motor twitch at < 0.3 mA
Haematoma/bleeding	↑ with anticoagulants	Follow ASRA/SASA anticoagulation intervals

Intravenous Regional Anaesthesia (Bier Block)

• LA: Prilocaine 0.5 % 3 mg kg⁻¹ (max 400 mg) or Lidocaine 0.5 % 1.5 mg kg⁻¹ (max 200 mg); no additives or adrenaline.
• Minimum tourniquet time 30 min; safe deflation technique–release 5 s, re-inflate 1 min, final release.
• Contra-indications: Sickle cell disease, severe peripheral vascular disease, infection, crush injury.
• Post-deflation: observe ≥ 20 min for LAST.

Block Performance & Monitoring

• Triple safety–real-time ultrasound + low-current nerve stimulation (≤ 0.5 mA, 0.1 ms) + Opening Injection Pressure (OIP) < 15 psi.
  1. Connect needle to nerve stimulator (0.5mA, 0.1msec, 2Hz)
  2. Advance needle towards the nerve or plexus
     • Needle adequately placed as seen on US
       • No twitch
       • 1-2 mL injection of LA results in adequate spread in the desired tissue plane OIP normal <15psi
     • Needle adequately placed as seen on US
       • Twitch present
       • Reposition the needle to assure NO twitch present at <0.5mA
         • 1-2 mL injection of LA results in adequate spread in the desired tissue plane OIP normal <15psi
  3. Complete injection
• No response:
  • Increase current to 1.5mA
  • Adjust needle placement by US
• Document volume, concentration, adjuvants, site, side, complications in the regional register (SASA QI requirement).
• Sedation: follow Procedural sedation guideline; full ASA monitoring if midazolam / propofol used.

Evidence

Use and Outcome Benefit

Approach	Typical operations (proven benefit)	Representative evidence & key outcomes*
Interscalene (ISB)	Total shoulder arthroplasty, rotator-cuff repair, clavicle fixation	Meta-analysis of 14 RCTs (≈1200 pts, 2022) – pain scores ↓ > 3 cm Was for 24 h, IV morphine-equivalent ↓ 22 mg, earlier physiotherapy; but 94 % hemi-diaphragm paresis
Superior/Upper trunk	Shoulder arthroscopy, open Bankart repair	Systematic review 2023 – analgesia non-inferior to ISB with diaphragm paresis ↓ to ≈15 %, fewer dyspnoea events, earlier discharge
Supraclavicular (SCB)	Mid-humerus plate, elbow arthroplasty, radial-forearm free flap	RCT 2024 (n = 120)–success 98 %, opioid use first 12 h ↓ 40 % vs axillary; quicker onset than infraclavicular for elbow surgery; pneumothorax 0 % under ultrasound
Costoclavicular (CCB)	AV-fistula creation, distal humerus fixation, outpatient hand surgery catheters	BJA 2024 RCT–block success 100 %, diaphragm paresis 4 %, catheter dislodgement 2 % (vs 12 % infraclavicular), analgesia identical; cohort 2024 confirmed <10 % phrenic involvement
Infraclavicular (ICB)	Elbow, forearm, wrist surgery when complete tourniquet cover needed	Medicine 2024 meta-analysis–longer motor block and block duration than SCB; fewer paraesthesiae than SCB; similar surgical readiness time
Axillary	Carpal tunnel, metacarpal/phalangeal fixation, tendon repair	2023 network meta-analysis–no difference in surgical anaesthesia vs SCB, but time-to-block longest; high patient satisfaction; musculocutaneous must be blocked separately
Distal single-nerve blocks (median, ulnar, radial, musculocutaneous)	Wrist arthroscopy, trigger-finger release, tendon transfers	RCT 2019–equivalent OR readiness and lower tourniquet pain vs SCB; preserves proximal motor, allows immediate elbow mobilisation
Intravenous regional anaesthesia (Bier)	Short (< 60 min) reduction / fixation, foreign-body removal	Prospective trial 2021–pain control equivalent to wide-awake local; shorter theatre time; but tourniquet discomfort limits > 90 min cases

Practice Points

• Shoulder surgery–where respiratory compromise exists, superior trunk block or combined suprascapular + axillary blocks provide comparable analgesia with greatly reduced diaphragm impairment.
• Elbow and forearm–costoclavicular or infraclavicular blocks give faster readiness and more reliable tourniquet tolerance than axillary.
• Hand surgery day-case–axillary or distal blocks minimise motor block of proximal joints, facilitating same-day physiotherapy.
• Home catheters–costoclavicular catheters show lower dislodgement and superior patient-reported quality-of-recovery scores compared with interscalene catheters.
• IVRA remains the simplest technique for very short procedures but offers no post-operative analgesia; wide-awake local anaesthesia-no tourniquet (WALANT) may further reduce theatre time for carpal-tunnel release.

Safety & Outcome-linked Dosing

LA concentration (single-shot)	Volume range	Target duration	Evidence-based comment
0.5 % Ropivacaine	10-15 mL (STB) / 15-25 mL (SCB/CCB)	10-14 h	RCTs show no increase in LAST at ≤ 3 mg kg⁻¹ total
0.5 % Levobupivacaine	20-30 mL (ICB/Axillary)	12-18 h	Longer motor block; preferred for prolonged tourniquet
0.25 % Ropivacaine continuous catheter	5-8 mL h⁻¹	Up to 72 h	Cost–effective for day-case shoulder arthroplasty
0.5 % Prilocaine (IVRA)	3 mg kg⁻¹ (max 400 mg)	Up to 60 min	Failure rate < 3 % when 30-min cuff rule observed

Complication Trends (Ultrasound era)

Complication	Reported rate	Comment
LAST	0.01 % upper-limb blocks; virtually zero in distal blocks	Relates directly to total mg injected; keep < 3 mg kg⁻¹ bupivacaine equivalents
Pneumothorax	0–0.7 % SCB; none with CCB, ICB, distal	Use linear probe in coronal orientation and visualise pleura
Persistent neurological deficit	0.2 % (all)	High opening-pressure injection triples risk
Diaphragmatic paresis	94 % ISB, 15 % STB, < 10 % CCB/ICB	Consider patient comorbidities

Nerve Injury After Peripheral Nerve Block–Recognition & Evidence-Based Pathway

Definition

• New pain, paraesthesia, numbness or motor weakness persisting > 48 h after the expected resolution of block (≈ 24 h for single-shot long-acting local anaesthetic).
• May be partial (sensory-only) or complete (sensorimotor).

Incidence of Nerve Injury After Peripheral Nerve Block

Category of deficit	Operational definition	Best-estimate incidence
Permanent neurological deficit	Persistent sensorimotor symptoms ≥ 12 months	≤ 0.04 % (≈ 1: 2 500 blocks)
Transient neuropraxia	New sensory ± motor deficit lasting > 7 days but resolving < 12 months	0.8–2 %

• Figures derived from large prospective registries (> 170 000 blocks) and multicentre observational studies published 2017-2024.
• Most injuries are neurapraxic and resolve within 12 weeks.

Principal Mechanisms

• Needle or catheter trauma (especially intrafascicular placement)
• High-pressure or intraneural injection causing ischaemia–reperfusion injury
• External compression–tourniquet, tight dressings, extreme positioning
• Surgical traction, haematoma, or oedema around the nerve

Immediate Actions (Day 0–1)

1. Review records–block details, needle type, LA dose, surgical notes, tourniquet pressure/duration, anticoagulation.
2. Focused neuro-examination–document dermatomal sensation, strength (Medical Research Council scale) and compare with contralateral limb.
3. Escalate–inform operating surgeon, block anaesthetist and Acute Pain/Regional Team.

Algorithm

Clinical picture	Key steps in first 48 h	Subsequent pathway
Mild, improving sensory symptoms	Reassure; optimise analgesia; provide patient information leaflet	Review in 2 weeks → if fully resolved, discharge; if persistent, proceed as for “sensory-only persistent”
Persistent sensory deficit at 2 weeks	Arrange outpatient neurophysiology at 3–4 weeks (NCS/EMG)	• If normal → reassure, physio, re-review 6–8 weeks • If abnormal → formal Neurology referral ± MRI
Any motor weakness or worsening deficit	Urgent imaging to exclude compressive lesion (US or MRI within 24 h); check platelet count & coagulation	• Haematoma/space-occupying lesion → surgical decompression • No SOL → same pathway as above but Neurology referral within 48 h
Severe pain out of proportion + motor deficit	Consider compartment syndrome; measure pressures; maintain normotension	Emergency fasciotomy if indicated

• Timing rationale: meaningful EMG/NCS requires Wallerian degeneration (≈ 3 weeks). Earlier studies give false reassurance

Investigations

• Ultrasound (bedside)–detects haematoma, nerve swelling or transection.
• MRI neurography–delineates nerve continuity, oedema, scarring.
• Laboratory–CK, full blood count, INR if haematoma suspected.

Management

• Conservative–neuropathic analgesics (duloxetine, gabapentin), physiotherapy, occupational therapy, psychological support.
• Surgical–indicated for laceration, entrapment, enlarging haematoma or nerve sheath tumour. Early (< 3 months) neurolysis or grafting improves outcome.
• Documentation & Duty of Candour–explain events, expected course, planned follow-up; record in regional-block register and national incident system.

Follow-up Schedule

Timepoint	Action
48 h phone call	Reassess symptoms; reinforce advice
2 weeks clinic	Repeat neuro-exam; triage investigations
6–8 weeks	Review results; decide discharge vs ongoing care
≥ 3 months	Refer to specialist nerve injury unit if no improvement

Links

• Lower limb blocks
• Local anaesthetics
• Truncal blocks
• Anticoagulation and blocks
• Ortho regionals
• Shoulder surgery

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References:

1. Wai, C. L. W. and Irwin, M. G. (2012). Regional blocks in orthopaedics. Anaesthesia &Amp; Intensive Care Medicine, 13(3), 89-93. https://doi.org/10.1016/j.mpaic.2011.12.004
2. Horlocker, T. T., Vandermeuelen, E., Kopp, S. L., Gogarten, W., Leffert, L., & Benzon, H. T. (2019). Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: american society of regional anesthesia and pain medicine evidence-based guidelines (fourth edition). Obstetric Anesthesia Digest, 39(1), 28-29. https://doi.org/10.1097/01.aoa.0000552901.03545.fb
3. Checketts, M. R. (2016). Intravenous regional anaesthesia. Anaesthesia &Amp; Intensive Care Medicine, 17(4), 192-193. https://doi.org/10.1016/j.mpaic.2015.12.013
4. FRCA Mind Maps. (2024). Retrieved June 5, 2024, from https://www.frcamindmaps.org/
5. Anesthesia Considerations. (2024). Retrieved June 5, 2024, from https://www.anesthesiaconsiderations.com/
6. Boutique Workshops. (n.d.). In NYSORA. Retrieved June 26, 2024, from https://www.nysora.com/mec-category/boutique-workshops/
7. ASRA Pain Medicine. (n.d.). Guidelines. Retrieved June 27, 2024, from https://www.asra.com/guidelines-articles/guidelines
8. European Society of Regional Anaesthesia & Pain Therapy (ESRA). (n.d.). Guidelines. Retrieved June 27, 2024, from https://esraeurope.org/guidelines/
9. Teaching videos
10. Shen Y, et al. Ultrasound-guided costoclavicular vs supraclavicular block for upper-limb surgery: randomised trial. Br J Anaesth 2024;133:114-22.
11. Abdallah FW, et al. Superior trunk block as a phrenic-sparing alternative to interscalene block: systematic review. Reg Anesth Pain Med 2023;48:375-84.
12. Lee Y, et al. Diaphragm-sparing efficacy of costoclavicular block: prospective cohort study. Korean J Anesthesiol 2024;77:312-20.
13. Pehora C, et al. Combined dexamethasone and dexmedetomidine for brachial plexus block: meta-analysis. Anesthesiology 2024;140:621-35
14. Nienaber LN, et al. Ultrasound-guided brachial plexus block: SA experience. SAJAA 2022;28:180-6.
15. Jurgens FX, et al. Magnesium sulphate as an adjuvant in SAP block: randomised study. SAJAA 2022;28:94-101.
16. StatPearls. Intravenous Regional Anaesthesia (Bier Block). Updated 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430760/
17. Gray A, et al. Prilocaine vs lidocaine for Bier block: comparative study. Anaesth Intensive Ther 2024;56:88-95.
18. Southern African Society of Anaesthesiologists. Guidelines for peripheral nerve blocks and local anaesthetic safety. Johannesburg; 2024.
19. Neal JM, et al. ASRA Practice Advisory on neurologic complications associated with regional anaesthesia. Reg Anesth Pain Med 2023;48:455-64.

Summaries:
Superior trunk block
Suprascapular and axillary nerve block
Brachial plexus blocks
Elbow and wrist blocks

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© 2025 Francois Uys. All Rights Reserved.

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