Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know

Table 2 Summary of upper extremity peripheral nerve blocks

Block	Clinical application	Nerves blocked	Anatomical landmarks	Advantages	Disadvantages	Complications
Interscalene nerve block	Surgeries involving the shoulder, proximal aspect of humerus and the distal aspect of the clavicle	(1) Brachial plexus:C5 to C7; and (2) Cervical plexus: Supraclavicular nerve (C3 and C4)	LA injected between anterior and middle scalene muscles lateral to carotid artery and internal jugular vein	(1) Easy to perform; and (2) Comfortable for the patient	(1) Hemidiaphragmatic paralysis leading to respiratory compromise in patients with severe COPD; and (2) Not sufficient for elbow, forearm or hand surgeries	(1) Phrenic nerve palsy (100%); (2) Horner syndrome; and (3) Hoarseness
Supraclavicular nerve block	Surgery of the arm, elbow, forearm and hand. Extension into the interscalene area can cover shoulder procedures	C5-T1	LA injected above the clavicle between anterior and middle scalene muscles at the level of the first rib, where the subclavian artery crosses over it	(1) Fast onset; (2) Easier to perform; and (3) Comfortable for the patient	Relatively higher incidence of pneumothorax	(1) Pneumothorax; (2) Phrenic nerve palsy; and (3) Hoarseness
Infraclavicular nerve block	Surgery of the arm, elbow, forearm and hand	C5-T1	LA injected around the axillary artery below the clavicle, medial to coracoid process	Good choice for catheter placement	(1) Deeper block to perform; and (2) Greater discomfort during block placement	Pneumothorax (relatively low incidence)
Axillary nerve block	Surgery of the elbow, forearm and hand	Median nerve, ulnar nerve, radial nerve, and musculocutaneous nerve	LA injected around the axillary artery at the medial aspect of proximal arm	(1) Easy to perform; and (2) Low complication rate	(1) Often spares the musculocutaneous nerve; and (2) Requires arm abduction	(1) Hematoma formation; and (2) Intravascular injection

COPD: Chronic obstructive pulmonary disease.