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What are the major approaches to blocking the brachial plexus and their indications for use?
There are four major approaches to blocking the brachial plexus:
· The interscalene approach is performed at the level of the nerve roots and is ideal for surgical procedures of the shoulder and upper arm.
· The supraclavicular block, which produces a fast onset of anesthesia because of the compact nature of the divisions in the plexus, is also appropriate for surgical procedures of the upper arm.
· The infraclavicular approach is indicated for surgeries that include the elbow and hand. It is ideal for patients who are unable to abduct and extend their arms in order to perform an axillary block. This approach is also exem-plary for continuous postoperative analgesia because of the ease of catheter stabilization on the chest wall.
· The axillary block is performed at the level of the termi-nal branches and is ideal for surgeries distal to the elbow. Frequently, the musculocutaneous nerve is missed during this block.
To avoid nerve injury during performance of peripheral blocks, they should not be performed while the patient is under general anesthesia.
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