By Fritz Lothar Jenkner M.D., F.I.C.S., F.N.Y.C.S. (auth.)
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Extra info for Peripheral Nerve Block: Pharmacologic — By Local Anesthesia. Electric — By Transdermal Stimulation
Local Anesthetic: For diagnostic purposes use short (fast)-acting drug, for therapeutic effects long-acting drug. (2 to 3 to) 5 ml usually suffice. 5 (4 to 10) hr. 55 56 I • 57 Thoracic Sympathetic Block Basic Remark: This block will be carried out rather seldom, because a stellate block will cover the sympathetic block of the segments thoracic 1 to 4 if ample solution is used (about 10 ml). Likewise, a splanchnic or high lumbar sympathetic block will cover the thoracic segments 6 to 12. These facts have been proven by admixing contrast Xray medium to the local anesthetic solution.
Point of Block: Brachial plexus in its course over first rib (approach A) or on humerus (approach B). 5. Procedure: (A) Supraclavicular approach. 8 mm caliber with short bevel) attached to a 10 ml syringe, both filled with solutions, is inserted through the weal in a somewhat medio-dorsal direction. It should point to the spinous process of the third thoracic vertebra. If paresthesias are provoked, the needle should be arrested immediately. 5 to 2 em below the skin. In no case should the needle be advanced more than 3 em.
The neurovascular lodge is held in place. With the index and middle fingers of the left hand. 5 em needle is advanced just anterior to the brachial artery. Injection of 10 ml of solution after aspiration. Then withdrawal of needle to place it posterior to artery and injection of another 10 ml (maximally). After up to 30 min, motor paresis of fingers and full analgesia should ensue. Duration over 3 hr. Evaluation of Effect: Motor paresis of arm and finger muscles should appear. This is always the case if paresthesias have been provoked.