Injuries to the hand and forearm consistently hold a high place in the incidence of bodily trauma. They often need to be repaired immediately. Unfortunately, the stomach is often full of food and drink or there are multiple injuries which make the use of a general anesthetic a dangerous procedure.
The supraclavicular brachial plexus block has often been employed. However, this block has many disadvantages: First, it is accomplished by pneumothorax and/or phrenic nerve paralysis in 2 to 25% of cases reported.1 Such a complication might well prove overwhelming to the patient with a severe chest injury. Second, the block is effective in only 68 to 90% of cases.2 Consequently, general anesthesia is often reluctantly used to augment this block.
The local use of anesthetic agents throughout the field of trauma is to be decried for many reasons, among which are the spreading of infection in an open wound,