ESRA Academy. Prins N. Sep 8, 2016; 138342; 0177 Topic: Upper Limb Blocks - Brachial Plexus Block
Mr. Niko Prins
Mr. Niko Prins

Access to Premium content is currently a membership benefit.

Click here to join ESRA or renew your membership.

Discussion Forum (0)
Rate & Comment (0)
Background and Aims:

The Birmingham Hand Centre at the Queen Elizabeth Hospital Birmingham (QEHB) provides trauma and elective tertiary hand services for the West Midlands, undertaking approximately 3500 operative procedures each year. The regional block service has developed alongside the hand service and the Physicians’ Assistant (Anaesthesia) (PA(A)) role has become integral to the delivery of an efficient service.

The aim of the review is to demonstrate that Physicians’ Assistants (Anaesthesia) continue to provide an effective service in ultrasound-guided upper limb regional anaesthesia.


Upper limb nerve blocks at the Birmingham Hand Centre are performed under ultrasound guidance along with nerve stimulation.
PA(A)s, trainee anaesthetists and most consultant anaesthetists use a 50:50 mix of 0.75% ropivacaine and 2% lignocaine with 1:200.000 adrenaline as the local anaesthetic agent.
Investigation examined the number of blocks according to grade, top-up rates and volumes of local anaesthetic used.


2510 upper limb axillary brachial plexus blocks were recorded between January 2015 and April 2016, with the majority of these performed by PA(A)s (60%).
Top-up rates by grade were similar for consultants (3%) and PA(A)s (3.5%), but increased to 6.5% for trainees.
The median local anaesthetic volume administered for the primary block is similar between consultants (25ml), PA(A)s (25ml) and trainees (26ml).


Preliminary results show that PA(A)s continue to provide an effective axillary brachial plexus anaesthetic block service, with similar primary success rates to consultant anaesthetists. Total volumes of local anaesthetic for primary blocks are similar across all groups but trainees administer a higher total volume due to the increased top-up requirements.

Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.

Save Settings