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Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W. Tan, Michael T. Freehill, and John H. Wilckens J Bone Joint Surg Am Volume 95(24):e197 December 18, 2013 ©2013 by The Journal of Bone and Joint Surgery, Inc.

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Page 1: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients

by Umasuthan Srikumaran, Benjamin E. Stein, Eric W. Tan, Michael T. Freehill, and John H. Wilckens

J Bone Joint Surg AmVolume 95(24):e197December 18, 2013

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 2: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

Brachial plexus anatomy.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 3: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

The dermatomes anesthetized are shown in dark blue.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 4: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

Surface anatomy of the neck showing the relative midpoint (x) of the posterior border of the sternocleidomastoid muscle (solid line).

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 5: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

The dermatomes anesthetized are shown in dark blue.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 6: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

The highlight shows the region of the brachial plexus (nerve roots and root-trunk transition) targeted by an interscalene nerve block.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 7: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

Surface anatomy.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 8: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

The dermatomes anesthetized are shown in dark blue.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 9: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

The highlight shows the region of the brachial plexus (trunks) targeted by a supraclavicular nerve block.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 10: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

Surface anatomy.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 11: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

The dermatomes anesthetized are shown in dark blue.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 12: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

The highlight shows the region of the brachial plexus (cords) targeted by an infraclavicular nerve block.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 13: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

Surface anatomy.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 14: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

The dermatomes anesthetized are shown in dark blue.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 15: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

The highlight shows the region of the brachial plexus (terminal branches) targeted by an axillary nerve block.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.

Page 16: Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients by Umasuthan Srikumaran, Benjamin E. Stein, Eric W

Surface anatomy.

Umasuthan Srikumaran et al. J Bone Joint Surg Am 2013;95:e197

©2013 by The Journal of Bone and Joint Surgery, Inc.