Brachial Plexus Block Anesthesia Mnemonic
3 Musketeers were Assassinated by 5 Rats, 4 Mice And 2 Unicorns
Musculocutaneous nerve – C5, C6, C7
Radial nerve – C5, C6, C7, C8, T1
Median nerve – C6, C7, C8, T1
Axillary nerve – C5, C6
Ulnar nerve – C8, T1
Here are some brachial plexus block anesthesia key points to review for the board exam:
Anatomy:
- The brachial plexus is formed by the ventral rami of C5-T1 nerve roots, which combine to form trunks, divisions, cords, and terminal branches.
- Key landmarks include the interscalene groove, supraclavicular fossa, infraclavicular fossa, and axillary fossa.
Approaches:
- Interscalene Block: Targets the roots/trunks of the brachial plexus. Ideal for shoulder and upper arm surgeries.
- Supraclavicular Block: Targets the trunks/divisions. Suitable for surgeries of the arm, elbow, and forearm.
- Infraclavicular Block: Targets the cords. Used for surgeries of the elbow, forearm, and hand.
- Axillary Block: Targets the terminal branches. Best for surgeries of the forearm and hand.
Common Agents:
- Lidocaine: Rapid onset, moderate duration.
- Bupivacaine: Longer duration, more potent.
- Ropivacaine: Similar to bupivacaine but with less cardiotoxicity.
- Mepivacaine: Intermediate duration, less vasodilation.
Indications:
Suitable for surgeries of the upper extremity, including shoulder, arm, elbow, forearm, and hand procedures.
Contraindications:
Patient refusal, infection at the injection site, severe coagulopathy, and allergy to local anesthetics.
Complications:
- Nerve Injury: Rare but serious.
- Hematoma: Due to vascular puncture.
- Pneumothorax: Particularly with supraclavicular and infraclavicular approaches.
- Local Anesthetic Systemic Toxicity (LAST): Due to inadvertent intravascular injection.
Advantages:
- Provides excellent analgesia and muscle relaxation.
- Reduces the need for systemic opioids.
- Allows for postoperative pain control with continuous catheter techniques.
Disadvantages:
- Requires anatomical knowledge and technical skill.
- Risk of complications such as nerve injury and pneumothorax.
For more anesthesiology mnemonics check this mnemonic book.
This post covers the points you need to know for your board exams as well as for teaching residents on the daily rounds. Medical professionals can't use the information here to treat their patients nor people can use the information her to treat themselves. If you are having any medical issues, contact your local emergency services or your primary care provider. Please refer to your doctor for medical advice.