Brachial plexus anesthesia: essentials of our current understanding.

Brachial plexus regional anesthesia has been a mainstay of the anesthesiologist’s armamentarium since Hall1 first reported the use of cocaine to block upper extremity nerves in 1884. The American Society of Regional Anesthesia and Pain Medicine (ASRA) has sponsored a unique educational endeavor to provide practitioners and academicians alike with a comprehensive resource pertaining to brachial plexus anesthesia. Initially presented as an all-inclusive workshop at its May 2001 meeting, the material is available in its entirety on the ASRA Web site (www.asra.com). This review is a summary that presents the essential scholarly work resulting from this effort. It strives to (1) serve as a review of pertinent brachial plexus anatomy, (2) compare the efficacy of brachial plexus approaches and techniques, (3) describe the complications inherent to brachial plexus anesthesia, and (4) present available evidence to guide selection of drugs. Because evidence-based data pertaining to brachial plexus anesthesia is incomplete, we acknowledge informational gaps and emphasize areas in which we believe further study is needed. Readers desiring a more in-depth discussion of specific topics will find it in the Web site source documents, which also include additional anatomic photographs. Brachial Plexus Anatomy