Using Physical Examination in Supraclavicular Brachial Plexus Block with Modified Parascalene Approach

Background: Because nerve stimulators are not always available for brachial plexus block, fmding the right injection spot for nerve blocks is important. In this study we used physical examination to determine the appropriate spot for injection. Methods: All patients who were candidates for upper extremity surgery and were either in class ASA I or ASA II, were selected. Paresthesia was elicited in the operation field and the three middle digits using the physical examination method. 50 cases were included totally. Results: Paresthesia in the operation field or the three middle digits was elicited in 46 cases in which complete block was produced by local injection (success rate: 100% ). Paresthesia was elicited in the shoulder region in 3 cases and in the upper arm in 1 case. In the latter case complete block was achieved by blind local injection. In the former three cases general anesthesia was necessary. No adverse effects were seen. Conclusion: Apparently, eliciting paresthesia in the operation field and the three middle digits before injecting the anesthetic solution will increase the success rate and reduce adverse effects. MJJRJ, Vol. 19, No.4, 313-317, 2006.