José Ramón Saucillo-Osuna

By Ciro Alfonso Rodríguez-Gómez, José Ramón Saucillo-Osuna and Karen L. Iñiguez-López

The shoulder joint and clavicle are innervated by the brachial plexus, the cervical plexus, and nerves to muscles around the joint and clavicle. Regional anesthesia is aimed at producing optimal surgical conditions, prolonging postoperative analgesia, being free of complications, reducing costs, and minimizing hospital stay. Regional upper extremity anesthesia can be achieved by blocking the brachial plexus at different stages along the course of the trunks, divisions, cords, and terminal branches. The gold standard of regional anesthesia for shoulder surgery is interscalene brachial plexus block plus cervical plexus block, but it is associated with a high rate of neurological complications and phrenic nerve block. The interest of the anesthesiologist has been directed towards regional blocks avoiding these complications; techniques that approach nerves more distally than interscalene block have been described. These approaches include supraclavicular nerves, upper trunk, suprascapular nerve by anterior approach, axillary nerve block in the axillary fossa, clavipectoral fascia block. The objective of this chapter is to describe the anatomy, sonoanatomy, technique, and the clinical utility of these accesses.

Part of the book: Topics in Regional Anesthesia

By José Ramón Saucillo-Osuna, Eduardo Antonio Wilson-Manríquez, Mercedes Nicte López-Hernández and Ana Lilia Garduño-López

Caesarean section is associated with moderate to severe postoperative pain during the first 24 hours after surgery. Inadequate pain management can influence recovery, maternal psychological well-being and breastfeeding. In the search of alternatives to minimize the use of systemic opioids, new recommendations have been made to implement protocols to improve recovery after caesarean section, with multimodal analgesia, new suggestions for neuraxial techniques, regional analgesia with ultrasound-guided fascial plane blocks and non-pharmacological approaches. Some of the interventions, such as epidural or spinal blocks, although effective, carry a significant risk of complications (for example post-puncture headache). In their place, newer alternatives such as interventions guided by ultrasound are safe and effective for relieving pain in this common clinical context. The goal of this chapter is to provide clinicians with up-to-date evidence for optimal pain management after elective caesarean section.

Part of the book: Topics in Postoperative Pain