Background: With respect to the complications of upper extremity anesthesia and reports of less-complicated infraclavicular approach with the guide of coracoid, the present study was performed to determine the efficacy of infraclavicular brachial plexus block in upper extremity anesthesia in Imam Hossein and Akhtar hospitals in 2000.Materials and methods: This clinical trial of before and after type was conducted on 40 patients referred for upper extremity surgeries. Coracoid was determined as the guide point and needle was inserted 2cm below and 2cm medial to the coracoid. Following the paresthesia, 35cm lidocaine 1.5% was injected. Pinprick test was used to define upper extremity anesthesia. Meanwhile, complications were recorded.Results: The study population included 20 males with the mean age (±SD) of 31.9±11.7 and 20 females with the mean age of 36.2±11.8 years. Anesthesia was complete in 90% of cases (p<0.001). Vascular perforation was recorded in 7.5% of patients. Pneumothorax and neuropathy was not reported.Conclusion: Infraclavicular approach under coracoid guide is a suitable technique with few complications. Further studies dealing with the level of anesthesia in comparison to other techniques are recommended.

Color Doppler ultrasound-guided regional block like brachial plexus block lately changed other anesthesia and analgesia practice because of the accuracy and simplicity of practice to view the anatomy of blood vessels and nerves. With color Doppler ultrasound-guided regional block you can follow needle track to nerves and prevent any vessel puncture. It can be the standard for any regional block. The patient was a 64 years Iranian who had diabetes mellitus and hypertension and planned as an urgent right upper limb amputation surgery. Because of the acute exacerbation of COPD due to pneumonia we decided to use regional anesthesia for this patient. On the first physical examination there was no peripheral pulse in patient’ s right hand. With ultra-sonographic color Doppler the pulselessness of right hand artery were monitored. With the anatomic and awareness of grey-scaled ultrasonography the nerves and vessels were found. Axillary brachial plexus block with guidance of grey-scaled ultrasonography were done and the surgery was successfully performed and patient transferred to ICU for post operation care after surgery.

Background: Because nerve stimulators are not always available for brachial plexus block, finding 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.

This blinded, randomized experimental study was designed to evaluate the analgesic effects of adding epinephrine or xylazine to lidocaine solution for brachial plexus block (BPB) in sheep. Nine healthy, fat-tailed female lambs (26.6±1.5 kg) were randomly allocated into three groups: lidocaine 2%, 5 mg kg-1 (LID, n=6), lidocaine (5 mg kg-1) with epinephrine 5 mg mL-1 (LIDEP, n=6) or lidocaine (5 mg kg-1) with xylazine 0.05 mg kg-1 (LIDXY, n=6). Each animal was tested twice. The sheep received a total volume of 0.25 mL kg-1 for BPB. A nerve stimulator was used to locate the nerves of the brachial plexus. Onset and duration of analgesia of the forelimb were evaluated using superficial and deep pin prick and pinching of skin with a hemostat clamp. Heart and respiratory rates, and rectal temperature were recorded before and at predetermined intervals following the completion of the block. Brachial administration of LID, LIDEP or LIDXY produced forelimb analgesia within 11.3, 11.0 and 7.0 minutes, respectively. The mean duration of analgesia was 100.0 min in LID and 133.2 min in LIDEP group. The mean duration of analgesia in LIDXY group (186.8 min) was significantly longer compared with LID group. In LIDEP group a significant increase in heart rate occurred 5 min after drug administration. Heart rate decreased from 35 to 80 min in sheep received LIDXY. In conclusion, the addition of xylazine to lidocaine solution for BBP provided a prolonged duration of action without any adverse effects in fat-tailed sheep.

Patients with Grade III obesity pose unique challenges to the treating anesthesiologists. The challenges range from difficulty in intravenous cannulation to airway management. Regional anesthesia is advantageous over general anesthesia as it avoids airway manipulation, prevents reduction in functional residual capacity, and provides good postoperative analgesia. Regional anesthesia has its pitfalls like identifying the landmarks accurately and hemi diaphragmatic palsy following brachial plexus block. Hemi diaphragmatic palsy is poorly tolerated in grade III obese patients leading to increased peri-operative morbidity which undermines the advantages of regional over general anesthesia. Ultrasound-guided costoclavicular brachial plexus block (CCBPB) has the benefit of reduced hemi diaphragmatic palsy, avoiding pleural injury, and wider distribution of sensory blockade. Costoclavicular block has been administered to obese patients in the past with great success. We are reporting a successful case of ultrasound-guided costoclavicular brachial plexus block performed in an obese patient with a BMI of 51. 56 Kg/m2.

Background: The objective of this study was to examine analgesia when using perineural dexamethasone compound in an interscalene brachial plexus block following shoulder surgery. Methods: This study was designed as a randomized, double-blind clinical trial. Patients meeting the specified criteria were randomly divided into two groups: The experimental group and the control group, each comprising 30 individuals. Age and gender were matched between the groups. The control group received lidocaine along with 2 cc of 0.5% bupivacaine (20 milligrams) and 2 cc of normal saline; however, the experimental group received lidocaine, along with 2 cc of 0.5% bupivacaine and 2 cc of dexamethasone. Pain levels were assessed using the Visual Analog Scale (VAS), and covariance analysis was applied for data analysis. Results: The results demonstrated that pain intensity was notably lower in the experimental (dexamethasone) group than in the control group at both the 12-hour group (P < 0.001) and 24-hour (P < 0.001) postoperative marks. Dexamethasone significantly reduced pain among the patients. Conclusions: In conclusion, administering dexamethasone to potential candidates for shoulder surgery could lead to prolonged analgesia for up to 24 hours after the surgery. Consequently, this medication can serve as an efficacious analgesic option for pain management in these patients.