الفهرس 
Brachial plexus architectureOnly 14 pages are availabe for public view
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Abstract
Upper limb surgeries are mostly performed under regional
blocks; regional blocks not only provide intraoperative anesthesia but
also provide a postoperative analgesia that extends for hours without
any systemic side effects.
Regional anesthesia such as a brachial plexus block (BPB)
involves injection of local anesthetic (LA) around nerves to block the
sensory and motor nerves that supply the operative site.
Supraclavicular approach is one of the different approaches of
brachial plexus block by different local anesthetics. The blind
approach which rely on surface landmarks before needle insertion
and elicitation of paresthesia or nerve-stimulated muscle contraction
after needle insertion with multiple trial and error needle attempts
result in procedure related pain and more risk of complications as
pneumothorax.
Ultrasound guidance has many advantages, as it can potentially
improve the success rate up to 99%, fastens the onset time and reduce
the risk of complications.
Many studies demonstrated the effects of cooling of the local
anesthetics increase its density and viscosity, thus limit the
intrathecal spread of bupivacaine, therefore increase the success rate
of the block and improve its onset. Cooling also decreases the
amplitude and increases the duration and the latency of the compound
action potential.