Article Text

other Versions

Download PDFPDF
Surgical anesthesia for proximal arm surgery in the awake patient
  1. Laura Girón-Arango1 and
  2. Anahi Perlas2
  1. 1Department of Anesthesia, Hospital Pablo Tobon Uribe, Medellin, Antioquia, Colombia
  2. 2Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Anahi Perlas, Anesthesia and Pain Management, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada; anahi.perlas{at}


This education article discusses a combination of brachial plexus and peripheral nerve blocks aimed at providing complete surgical anesthesia to the proximal arm, while consistently avoiding diaphragmatic paresis. This type of approach may be warranted in patients with respiratory compromise of any etiology. In these settings awake surgery is recommended to preserve respiratory function and at the same time minimize the risk of infection of the healthcare team by avoiding the aerosol-generating medical procedures associated with general anesthesia.

  • anesthesia
  • conduction
  • nerve block
  • ultrasonography
  • brachial plexus
  • upper extremity

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @PerlasAnahi

  • Contributors LGA wrote the first draft of the manuscript, prepared figures and approved the final manuscript. AP conceptualized the article, worked with a professional illustrator to develop some of the figures, edited the manuscript and approved the final version.

  • Funding This study was funded by American Society of Regional Anesthesia and Pain Medicine.

  • Competing interests AP has a research grant from Fisher and Paykel and she is executive editor of Regional Anesthesia and Pain Medicine.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.