Upper Limb Blocks: Advances in Anesthesiology Research

Abstract

To summarize the recent literature regarding regional anesthesia of the upper extremity. Brachial plexus anatomy is more variable than previously believed. Several novel techniques for upper extremity blockade have been recently described. The ability of local anesthetic adjuvants and liposomal bupivacaine to prolong block duration has been investigated with mixed results. Regional anesthesia has played an important role in the expansion of ambulatory upper extremity surgery, especially shoulder arthroscopy and arthroplasty. Knowledge about the management of local anesthetic systemic toxicity remains essential for the safe performance of upper extremity blocks. The widespread adoption of ultrasound guidance for nerve blocks and the increasing emphasis on value in healthcare have fostered numerous innovations in regional anesthesia of the upper extremity in recent years. Further research is needed to determine the best technique for diaphragm-sparing shoulder analgesia and the most appropriate role for liposomal bupivacaine.