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Peripheral nerve blocks for outpatient surgery: evidence-based indications

Lin, Emily; Choi, Jason; Hadzic, Admir

Current Opinion in Anesthesiology: August 2013 - Volume 26 - Issue 4 - p 467–474
doi: 10.1097/ACO.0b013e328362baa4

Purpose of review There has been an increasing use of peripheral nerve blocks (PNBs) in ambulatory surgery. Several recent reports have contributed to our understanding of the optimal PNB technique for specific surgical procedures in this setting. In this review, we have summarized the available literature on indications of PNBs for outpatient surgery of the upper extremity.

Recent findings Although many of the recent studies focus on technical aspects of PNBs, few center on evidence-based indications or their utility in the ambulatory setting. The available literature suggests that although multiple techniques have been reported for outpatient shoulder surgery, interscalene brachial plexus block (ISBPB) is currently the most preferred technique. Supraclavicular, infraclavicular, and axillary brachial plexus blocks, however, are all commonly used and effective PNBs for outpatient surgery and analgesia of the arm, forearm, and hand.

Summary ISBPB is currently the most beneficial PNB for outpatient shoulder surgery. Supraclavicular block functionally can be considered an alternative to the traditional ISBPB; however, additional studies are required before routine use can be recommended. Although the review identified several reports with benefits of one PNB technique over the others, the existing literature suggests that many of these techniques may be interchangeable with regards to procedures of the distal upper extremity. Future studies are indicated to help standardize the techniques, selection, and postoperative management of PNBs for specific surgical indications.

Department of Anesthesiology, St Luke's-Roosevelt Hospital Center, New York, New York, USA

Correspondence to Admir Hadzic, MD, PhD, Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025, USA. Tel: +1 212 523 2500; fax: +1 212 523 3930; e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.