Brachial plexus terminal nerve block in the humeral canal (“midhumeral block”)

The main terminal nerves of the brachial plexus can be located using peripheral nerve stimulation, and it is possible to block each one of them selectively by a single puncture point at the joint of the superior and mid thirds of the arm. In 1992 Louis-Jean Dupré demonstrated that the block at the humeral canal was reliable, simple, and effective. It is indicated for any elbow, forearm, wrist, or hand surgeries. The order in which the four nerves should be anesthetized is, according to Gaertner, who confirmed Dupre's blocking sequence, median, ulnar, radial, and musculocutaneous. Guntz stated that the radial nerve should be blocked before the ulnar nerve. Between 5 and 10 minutes are necessary to perform a block at the humeral canal. The block at the humeral canal is a safe technique with a high rate of effectiveness even for those with little experience. The complication rate is low. The tourniquet is well-tolerated. The technique is also useful for ambulatory and emergency surgeries. It allows a selective blockade, using different local anesthetics and adjuvants for each nerve.