Introduction

Pain is an extraordinary complex sensation which is difficult to define and equally difficult to measure in accurate objective manner. The International Association for the Study of Pain defines pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage’.¹

Many millions of patients worldwide undergo surgery every year and effective pain control is essential for optimal care of such patients. Truly the central axis of anesthesia is predicated on interruption of pain.

“Regional anaesthesia” is the term first used by Harvey Cushing in 1901 to describe pain relief by nerve block.² Regional nerve blocks are based on the concept that pain is conveyed by nerve fibers, which are amenable to interruption anywhere along their pathway.³

Peripheral nerve block avoids the unwanted effects of anesthetic drugs used during general anesthesia and the stress of laryngoscopy and tracheal intubation.⁴ It decreases the pain as analysed by VAS score post operatively. It also decreases the need of post operative analgesics, decreases incidence of PONV, shortens the post anesthesia care unit time and increases the patient satisfaction.⁵

Regional anesthesia traces its origin to Dr. Carl Koller who in 1884 employed a solution of cocaine for topical corneal anesthesia in patients undergoing eye surgery.⁶ This marked the start of a new era in medicine namely the use of regional anesthetics for prevention of pain associated with surgery.

Brachial plexus block is a popular and widely employed regional nerve block technique for perioperative anesthesia and analgesia for surgery of the upper extremity. William Halsted (1852–1922) performed the first brachial plexus block.^7,8 Using a surgical approach in the neck, Halsted applied cocaine to the brachial plexus. The first percutaneous supraclavicular block was performed in 1911 by German surgeon Diedrich Kulenkampff (1880–1967).⁹ There are various approaches which has been described for brachial plexus blocks viz. Supraclavicular, Interscalene, Infraclavicular, Axillary.  Supraclavicular approach is the easiest and most consistent method for surgery below the shoulder joint.¹⁰

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Dr Avinash Kumar, DNB Resident

Department of Anesthesiology And Critical Care, Bokaro General Hospital, Bokaro