Kadir Arslan, Ayça Sultan Şahin
Comprehensive Medicine - 2025;17(4):338-349
Peripheral nerve blocks are frequently preferred in orthopedic upper extremity surgeries because they provide adequate postoperative analgesia, reduce the need for general anesthesia, and accelerate recovery. The integration of ultrasound (USG) guidance into these techniques has improved block success rates and significantly reduced complications. USG-guided nerve blocks allow real-time visualization of neural structures and surrounding anatomy. The brachial plexus supplies most of the innervation of the upper extremity. In clinical practice, the four most commonly performed brachial plexus blocks are the inter-scalene, supraclavicular, infraclavicular, and axillary approaches. In addition, terminal nerves can be selectively blocked along their course. For example, in clavicular surgeries, the interscalene block is often combined with a cervical plexus block; in rotator cuff repair and shoulder arthroscopy, the interscalene block is preferred; in humeral shaft fractures and elbow arthroplasty, supraclavicular or infraclavicular blocks are commonly used; and in distal radius fracture fixation, wrist arthrodesis, and metacarpal fracture surgeries, the axillary block is frequently chosen. Median nerve blocks are useful in carpal tunnel release and tenosynovitis; ulnar nerve blocks are employed in Dupuytren's contracture and flexor tendon repair of the fourth and fifth fingers; while radial nerve blocks are beneficial in de Quervain's tenosynovitis, scaphoid fracture surgery, and dorsal hand lesions. This review discusses the anatomical basis, techniques, indica-tions, and complications of cervical and brachial plexus blocks, as well as distal nerve blocks, which are widely utilized in orthopedic upper extremity surgery.
