الفهرس 
Anatomy of the Brachial PlexusOnly 14 pages are availabe for public view
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Abstract
In recent years there has been a growing interest in the practice of regional anesthesia and, in particular, peripheral nerve blocks for surgical anesthesia and postoperative analgesia. Peripheral nerve blocks have been found to be superior to general anesthesia, as they provide effective analgesia with few side effects, and can fasten patient recovery.
Unfortunately the practice of regional anesthesia does not enjoy widespread endorsement especially in pediatrics. Also, because of inconsistent success, varying from one anesthesiologist to another. Current methods of nerve localization (e.g., parathesia and nerve stimulation) are essentially blind procedures, since they both relay on an indirect evidence in needle- to- nerve contact.
In this essay we focused light on application of ultrasound in blockage of the brachial plexus by supraclavicular technique to decrease the incidence of complication of blind techniques of supraclavicular block in pediatrics.
Seeking nerves by trial and error and random needle movement can cause complications. Although uncommon, complications such as intravascular local anesthetic injection resulting in systemic toxicity, pneumothorax following supraclavicular block, and nerve injury have been all reported.
Imaging guidance for nerve localization holds the promise of improving block success and decreasing complication. The most significant advantage of ultrasound technology is the ability to provide anatomic examination of the area of interest in real-time.
Other advantages for ultrasound imaging that allows one to visualize neural structure (plexus and peripheral nerves) and the surrounding structures (e.g., blood vessels and pleura), navigate the needle towards target nerves, and visualize the pattern of local anesthetic spread that makes the technique very safe in pediatrics.
Successful brachial plexus blocks rely on proper techniques of nerve localization, needle placement, and local anesthetic injection. Often, multiple trial-and-error needle attempts are necessary, resulting in procedure-related pain and complications. This is risky, particularly for the supraclavicular approach, because of the chance of pneumothorax. So, nowadays dependence on blind technique is very rare in pediatrics.
Ultrasound guidance for brachial plexus blocks can potentially improve success and complication rates. We hypothesized that ultrasound imaging can help localize the brachial plexus accurately and guide needle advancement to the target nerves in pediatrics.
Regional anesthesia is a safe and effective method of analgesia, especially as a supplement to general anesthesia. The benefits have been difficult to demonstrate in adults apply to children. In modern anesthesia using an endpoint of morbidity and mortality, it is very difficult to show a difference without very large numbers. Clearly defined endpoints need to be drawn to demonstrate a quantifiable improvement in outcome.