• Gabriel Enrique Mejia-Terrazas, María de Ángeles Garduño-Juárez, Marisol Limón-Muñoz, Areli Seir Torres-Maldonado, and Raúl Carrillo-Esper.
• División de Anestesiología, Instituto Nacional Rehabilitación, México, D. F., México. Electronic address: gisibyg@yahoo.com.mx.
• Cir Cir. 2015 Jul 1; 83 (4): 312-8.

BackgroundThe bilateral brachial plexus block is considered a contraindication, due to the possible development of complications, such as: toxicity from local anaesthetics or bilateral diaphragmatic paralysis. However, with the real time visualisation provided by the ultrasound scan, these complications have decreased and it is a safer procedure.Clinical CasesFour cases are presented where the bilateral block was performed using guided ultrasound, as the patients were unable to receive general anaesthesia due to a history of adverse effects or the use of opioids in the post-operative or by the prediction of a difficult airway associated with obesity. A systematic review of the literature from January 1993 to June 2013, was also performed by using a search in the MEDLINE, EMBASE, ARTEMISA, LILACS, Google data bases, in Spanish and English language with the following words: bilateral brachial plexus block, bilateral interscalene block, bilateral infraclavicular block, bilateral supraclavicular block, bilateral lateral supraclavicular block, bilateral axillary block, ultrasound-guided bilateral brachial plexus block.ConclusionBased on the evidence found, ultrasound-guided bilateral brachial plexus block in selected patients and expert hands, is no longer a contraindication.Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

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