Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients...

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Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W. Tan, Michael T. Freehill, and John H. Wilckens J Bone Joint Surg Am Volume 95(24):e197 December 18, 2013 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Transcript of Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients...

Page 1: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients

by Umasuthan Srikumaran, Benjamin E. Stein, Eric W. Tan, Michael T. Freehill, and John H. Wilckens

J Bone Joint Surg AmVolume 95(24):e197December 18, 2013

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 2: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

Brachial plexus anatomy.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 3: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

The dermatomes anesthetized are shown in dark blue.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 4: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

Surface anatomy of the neck showing the relative midpoint (x) of the posterior border of the sternocleidomastoid muscle (solid line).

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 5: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

The dermatomes anesthetized are shown in dark blue.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 6: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

The highlight shows the region of the brachial plexus (nerve roots and root-trunk transition) targeted by an interscalene nerve block.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 7: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

Surface anatomy.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 8: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

The dermatomes anesthetized are shown in dark blue.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 9: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

The highlight shows the region of the brachial plexus (trunks) targeted by a supraclavicular nerve block.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 10: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

Surface anatomy.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 11: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

The dermatomes anesthetized are shown in dark blue.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 12: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

The highlight shows the region of the brachial plexus (cords) targeted by an infraclavicular nerve block.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 13: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

Surface anatomy.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 14: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

The dermatomes anesthetized are shown in dark blue.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 15: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

The highlight shows the region of the brachial plexus (terminal branches) targeted by an axillary nerve block.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 16: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W.

Surface anatomy.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.