Regional Anesthesia for Bilateral Upper Limb Surgery

Surgeons are becoming increasingly interested in performing bilateral procedures at the same operation and this poses a challenge to the anesthetist considering regional anesthesia. While the demand for bilateral elective surgery may increase probably in the field of trauma, bilateral regional anesthesia of the upper limb will have the most benefit.Concerns are raised regarding the large doses of local anesthetic (LA) required and the risk of serious bilateral adverse effects such as phrenic nerve block or pneumothorax. However, there have been several advances in regional anesthesia, so these concerns may be reconsidered.Ultrasound guided regional anaesthesia and continous nerve catheter techniques have become increasingly popular.Local anesthetic drugs with safer side-effect profiles are now widespread and can provide effective anesthesia and analgesia at lower doses.Spacing blocks apart in time can further reduce potential toxicity issues, such that peak absorption rates for each block don’t coincide.