BRACHIAL PLEXUS BLOCK

(Including axillary, interscalene, supraclavicular & infraclavicular)

 

Anatomy

The brachial plexus is a group of nerves that control the arm and shoulder.  There are four approaches for this block, depending on which part of the arm has the pain.  These are axillary (underneath the arm), interscalene (side of the neck where the neck meets the shoulder), supraclavicular (above the clavicle, shoulder base), and infraclavicular (below the clavicle, shoulder bone).

 

Indications

The above-mentioned blocks are used for acute and chronic pain of the arm and/or hand, or shoulder.

 

Preparation for a Brachial Plexus Block

…         Do not eat or drink 6 hours before your appointment time.  This is very important.  This safety measure will prevent the aspiration of food into the lungs in case you become nauseated and vomit.

…         You must have someone with you to drive.  You may be given light sedation, which will impair your ability to drive.  You could injure or kill yourself or someone else if you try to drive.

…         The nurse will put a blood pressure cuff and a heart monitor on you.  An IV will be started.  Light sedation may be given to help you relax or a pain medicine may be put in your IV.

…         You will sign a consent form for the procedure before you are sedated.

…         You will be placed on your back with your affected arm straight down.  You will need to turn your head away from the affected arm.  This will help the doctor place the needle in the right place.

 

Benefits

…         Your arm will feel numb, therefore decreasing your pain.

…         The arm may feel warmer.

…         Because of the decrease in pain, you will be able to do more in physical therapy.

 

Possible Risks

…         Total spinal block

…         Cardiac arrhythmias

…         Laryngeal nerve block

…         Pneumothorax or punctured lung

…         Hematoma or bruise in the neck area

 

Frequency of Treatment

Brachial plexus blocks are often repeated every 2-4 weeks in a series of 6.  You will be evaluated before repeating a block.  Usually at least 2-3 blocks are done.

 

Things to Expect After a Block

…         Your affected arm may be weak or numb.  The nurse will give you a sling to wear.  Remember to bring the sling back on follow-up visits.  The numbness will resolve after 4-6 hours.

…         There may be some soreness at the needle puncture site.  Tylenol and a heating pad may be beneficial.