Conduction anesthesia of the upper extremity--a literature and technique review.

In 1600, Valverdi 1 achieved a type of sensory loss by compressing the vessels and nerves of a region until sensation was lost. James Moore 2, in 1784, observed similar results by compressing the nerve trunks supplying the upper extremity. In 1843, Alexander Wood 8 described the subdermic application of morphine sulfate in the vicinity of a painful area to relieve the symptoms. The year 1853 saw the introduction of the syringe and hollow metallic needle by Pravaz4 and Wood" respectively. Dr. William S. Halstead6 was probably the first person to produce chemical anesthesia of the entire upper extremity when, in 1884, under direct dissection of the neck, he exposed the individual nerve roots of the brachial plexus and topically applied a cocaine solution. In 1887, J. Leonard Corning 7 injected agents at the cutaneous antibrachial medialis nerve producing sensory loss along its distribution. A direct exposure technique, similar to Halstead's, was utilized by Dr. George W. Crile8 in 1897, during which time he injected cocaine solution endoneurally to produce anesthesia for a shoulder disarticulation. August Bier9, in 1908, demonstrated the intravenous injection of procaine to produce anesthesia of the entire upper extremity. In 1911, Hirschel'1 set the stage for modern percutaneous techniques with his description of a blind axillary approach in which he could selectively produce anesthesia of the upper extremity. Shortly after Hirschel's article, Kulenkampf 11 described a blind percutaneous technique, which he practiced on himself until perfected, whereby the brachial plexus was approached supraclavicularly at the level of the first rib, making multiple injections on parasthesias until the extremity was anesthetized. In 1916, Kappis12 described a paravertebral approach utilizing the spinous and transverse processes of the cervical vertebrae. A year later, Bazy' 1 introduced a percutaneous infraclavicular approach which was later modified by Babitzki 14 and Balog15. The infraclavicular technique apparently never gained a wide popularity, as it was not again mentioned in the anesthesia literature until 1973. At that time, Raj 6 x and associates described a modification utilizing an electronic nerve stimulator to locate the nerves of the plexus.