Technique Of Brachial Plexus Block Research Articles

Comparative Study between Ketamine and Magnesium Sulfate as Adjuvant to Bupivacaine in Ultrasound Guided Supra-Clavicular Brachial Plexus Block

Abstract Background In modern anesthesia practice, peripheral nerve block has a significant contributory role. Safety and accepted success rate have made this technique of anesthesia as very popular in ambulatory and inpatient anesthesia. Aim of the Work is to compare onset, degree of blockade, duration of blockade, duration of postoperative analgesia, and associated side effects after adding either magnesium sulfate or Ketamine to bupivacaine for performing supraclavicular Brachial Plexus Blocks for upper-limb surgeries. Patients and Methods After obtaining approval from the Research Ethical Committee of Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospital. Randomized controlled double blinded study. Results Regarding the assessment of sensory block in the study, Onset times (mean ± SD) were (22.15 ± 3.20) mins, (17.35 ± 4.12) and (15.42 ± 3.23) mins in control, Magnesium and ketamin groups respectively. Adding ketamine or Magnesium significantly fastened the onset of sensory block with a highly significant difference (P < 0.001) in comparison to control group. These results also demonstrated that Ketamin fastened the onset time more than Magnesium but there was no statistically significant difference between two groups. Conclusion Ultrasound guidance should be used as a routine technique for brachial plexus block and anaesthetists should gain experience in the application of ultrasound in all nerve blocks. Lower volumes and different types and concentrations of local anaesthetics should be tried in order to maintain effectiveness and decrease incidence of complications. Different doses of ketamin and magnesium sulfate should be tried to detect the ideal dose to be used as additive to local anaesthetics.

Electron microscopic examination of needles used in infraclavicular brachial plexus block

Aim: The application of peripheral block is frequently used in anesthesia practice. One of the most significant complications of this procedure is peripheral nerve damage that can develop due to the needles used. The aim of this study was to determine the presence of tissue residue on the needle and to obtain information about damage to surrounding tissues during this procedure by examining the needles used in brachial plexus block with electron microscopy. Methods: This prospective-cohort study included patients who were to undergo forearm or hand surgery in the Orthopedics Clinic under anesthesia with infraclavicular brachial plexus block performed with 2 different techniques: The local anesthetic agent was administered to the subclavian artery at 6 and 9 o’clock levels in Group 1 and 2, 6 and 9 o’clock levels in Group 2. The needles used during the block were preserved in glutaraldehyde solution then examined with electron microscopy. The presence of tissue on the needles was recorded and statistical evaluations were made. Results: The needles used in two different techniques of infraclavicular brachial plexus block were examined under scanning electron microscope. The amount of tissue residue remaining on the needle in Group 1 was significantly less than that in Group 2 (P<0.001). Conclusion: When it is considered that ultrasound provides a 2-dimensional image, the fewer the number of needle manipulations made during the procedure of brachial plexus block application, the less damage will be made to the surrounding tissues, thus reducing the possibility of mechanical nerve damage.

Comparative Study between Single, Double and Intra-Cluster Injection in Ultrasound-Guided Supraclavicular Brachial Plexus Block: A Randomized Trial

AbstractBackground: There are many different approaches for ultrasound-guided supraclavicular brachial plexus block. Each approach has a different success rate and complications.Aim of Study: The aim of this study is to compare intra-cluster injection technique compared with the most common supraclavicular approach single and double injection tech-niques.Material and Methods: Thirty-six patients received supr-aclavicular block were divided in to three groups. The total volume of local Anesthetic was 30ml 0.5% bupivacaine, In Gs (n=12) the whole volume was injected at corner pocket, while in Gd (n=12), half the volume of local anesthetic was injected at corner pocket and the other half was injected supero-lateral to subclavian artery. In Gic (n=12) the whole volume was injected inside main and satellite neural cluster. the onset time was recorded as the primary outcome.Results: Gic showed rapid onset compared to Gs and Gd (8.17±1.64 minutes, 18±2.45 minutes, 12.58±1.83 minutes, p<0.001) respectively. While Gd showed the longest duration than Gic and Gs (444.17±64.73 minutes, 310±50.09 minutes, 125.83±43.32 minutes, p<0.001) respectively. Time of first rescue analgesia was longer in Gd relative to Gic and G s (455±65.68 minute, 337.50±49.38 minutes, 136.67±49.10 minutes, p<0.001). Complication was noticed in only one patient in Gd.Conclusion: Intra-cluster technique for Supra-Clavicular Brachial Plexus Block showed rapid onset with adequate post-operative analgesia and minimal complications.

Brachial Plexus Block with Use of a Neurostimulator in a Striped owl (Asio clamator) Undergoing Wing Amputation

Background: The use of distinct drugs and techniques for establishing balanced anesthesia protocols has shown promising results in birds. The techniques of locoregional block can be incorporated to these protocols, thereby providing intra- and post-operative analgesia and reducing the requirement for general anesthesia. Additionally, the use of neurostimulators increases the chances of success and reduces the risk of toxicity; however, there are limited reports in the literature of its applicability in wild birds. Therefore, the aim of this study was to describe the brachial plexus block technique guided using a neurolocalizer in a striped owl (Asio clamator) submitted for right wing amputation.Case: A striped owl weighing 400 g with a history of exposed fracture of the right wing was supplied by the clinical sector at the Veterinarian Hospital of the Federal University of Bahia. Following hydration and stabilization of vital signs, the animal was referred to the surgical center for amputation of the limb. Dexmedetomidine (10 µg.kg−1 IM) was administered as premedication, and after 20 min, anesthetic induction was performed using sevoflurane (FiO2 = 100%) via a mask followed by maintenance using the same drug. The animal was positioned in a left lateral decubitus position with access to the brachial plexus determined by palpation and identification of the border of the following muscles: pectoral, cranial branch of the brachial biceps, and dorsal branch of the ventral serratus. The brachial plexus nerves are situated in the subcutaneous site craniodorsal to the axillary depression. For the block, a neurolocalizer was used, fixing the positive electrode to approximately 5 cm from the needle insertion site (21G × 2'”) in the axillary depression, which remained connected to the neurostimulator by the second electrode. At first, the needle was attached to the peripheral nerve stimulator using a pulse frequency of 1 Hz with an impulse duration of 0.1 ms and initial current of 1 mA. The needle was advanced in the direction of the nerve plexus until it was observed that muscular contractions and movement in the limb were blocked, gradually decreasing the contractions, which disappeared at a current of 0.3 mA. At this juncture, after verifying the absence of blood on aspiration, ropivacaine was injected (2 mg/kg) with a latency period of 20 min. Data were recorded via monitoring of vital signs (DigicareLifeWindowLW9xVet), recording an average hearth rate of 140 ± 9.84 bpm, respiratory rate of 30 ± 4.18 mpm, oxyhemoglobin saturation of 99%, end-tidal carbon dioxide of 26 ± 1.98 mmHg, and temperature of 37.4°C ± 0.11°C over the course of 20 min of the surgical procedure. No movements were observed in response to pain stimuli, and the animal exhibited normal recovery, free of excitation or signs of pain. Discussion: Considering the imprecise history regarding fracture time as well as the lack of specific tests to clearly elucidate the condition of this animal, selective and safe drugs were selected additionally: dexmedetomidine and sevoflurane, which provided superior quality of sedation during the handling of the animal and rapid and smooth anesthetic induction, respectively. Based on experiences with numerous species, the inclusion of the locoregional block has substantial value for lengthening the analgesic duration and quality in addition to reducing adverse effects inherent in general anesthesia. In the present study, the use of ropivacaine in the brachial plexus block with the use of a neurolocalizer in the striped owl was demonstrated to be easy to perform using the axillary approach, demonstrating efficacy confirmed by the stability of physiological variables and muscle relaxation as well as the absence of adverse events during recovery.

Comparative evaluation of two approaches of infraclavicular brachial plexus block for upper-limb surgeries.

Background:Infraclavicular approach is a common technique of brachial plexus block. The main difficulty of ultrasound guided technique is in needle visualization due to deep location of the cords. Hebbard et al described a retroclavicular approach wherein the needle was inserted posteriorly to the clavicle.Materials and Methods:In this prospective randomized controlled study, we have compared the classical technique with the retroclavicular approach in terms of needle visibility, block success rate, number of needle passes, block performance time, procedure-related pain, complications, patient and operator comfort and satisfaction.Results:The rate of block success was similar in both the groups. The needle tip and shaft visibility was more in the retroclavicular group (P < 0.05). The number of needle passes was also less in the retroclavicular group. Time for the block procedure was less in retroclavicular group when compared to the classical coracoid group. The patients reported less pain in retroclavicular group (P < 0.05).Discussion:Retroclavicular approach is a feasible option of infraclavicular brachial plexus block in Indian Subpopulation in terms of needle visibility and block success rate.

A comparative study between supraclavicular brachial plexus block and Infraclavicular brachial plexus block for upper limb orthopedic surgeries: A prospective, randomized, double-blind study

Introduction: Supraclavicular brachial plexus block is a common approach as it provides faster and dense blockade. In the past few years, infraclavicular brachial plexus block has become a method of increased interest as it has a lower complication rate and near to equal efficacy. The goal of this study was to compare block performance time, block characteristics, quality of block, patient's satisfaction, and complications between infraclavicular and supraclavicular techniques for brachial plexus block. Patients and methods: 100 subjects were randomized in a double-blind fashion, to receive either an infraclavicular block (Group I, n=50) or supraclavicular block (Group S, n=50) using nerve locator apparatus. Block performance time, onset, peak, duration of sensory and motor blockade, any change in hemodynamics, complications were recorded at scheduled intervals intra-operatively and post-operatively as per study protocol. Data were analyzed using GraphPad INSTAT version 3.06 software by Chi-square test or Mann-Whitney U test to compare categorical variables. Results: The block performance time was faster in the Group S compared to the Group I (4.8±4.4 minutes vs. 6.3±1.39 minutes, p <0.001). The sensory block onset time was faster in Group S compared to the Group I (6.9±1.58 minutes vs. 7.6±1.34 minutes, p=0.019). Other observed variables were considered statistically not significant. Conclusion: From our study, it is inferred that nerve locator guided Infraclavicular block by a vertical coracoid approach using multineurostimulation method is less rapidly executed as nerve locator guided supraclavicular block with a similar degree of surgical anesthesia and lesser complication rate.

Clinical comparison of two techniques of brachial plexus block for forelimb surgery in dogs

The objective of this study was to compare two different local anaesthesia techniques for intraoperative analgesia in dogs undergoing surgical procedures distal to the mid humeral diaphysis. Thirty-two dogs were divided into two groups: the US group received an ultrasound-guided brachial plexus block at the level of the first rib and the N group received a neurostimulation-guided paravertebral brachial plexus block. Ropivacaine 0.75% at 1.5mg/kg was injected in each case. Dogs were monitored during the surgical procedure, and rescue analgesia was administered whenever the heart rate, respiratory rate or blood pressure increased more than 20% from the basal values. Success rate was defined as no need for rescue analgesia during surgery and complete blockade of the operated leg evaluated just after anaesthesia recovery. Complications were also recorded. Data was analysed using Fisher exact and Mann/Whitney tests.Success rate was observed in 14/16 (87%) dogs and in 12/16 (75%) dogs in the US and N groups, respectively (P=0.65). Complications recorded were hypotension in three cases (US group, n=1; N group, n=2) and Horner’s syndrome in three cases (US group, n=1; N group, n=2; P=0.65). Both techniques were found to provide good level of analgesia that allowed performing the orthopaedic procedures from the mid humeral diaphysis and distal in the limb, without the need for further analgesia.

Risk factors for occurrence of failed interscalene brachial plexus blocks for shoulder arthroscopy using 20 mL 0.5% ropivacaine: a randomised trial.

Adequate pain management after arthroscopic procedures improves patients' satisfaction with the performed procedure, as well as facilitating early rehabilitation. The aim of the current randomised, prospective clinical study was to assess the influence of anthropometric parameters and the interscalene brachial plexus block (IBPB) technique on the quality of post-operational analgesia. 109 randomly selected patients of ASA I-III status were scheduled for elective shoulder arthroscopy. Reasons for non-inclusion were as follows: neurological deficit in the upper arm; allergies to amide Las; coagulopathy; and pregnancy. The patients received 20 mL of 0.5% ropivacaine for an ultrasound (US)-guided IBPB (group U), peripheral nerve stimulation (PNS)-confirmation IBPB (group N), or US-guided, PNS-confirmed IBPB (dual guidance; group NU). We observed that the studied groups did not differ in mean time of sensory and motor block terminations and, surprisingly, in each group in individual cases the sensory block lasted up to 890-990 minutes providing satisfactory long-lasting post-operational analgesia in patients receiving IBPB. We observed a negative correlation between BMI and termination of the motor block and a positive correlation between age and termination of the sensory block in patients receiving US-guided IBPB (group U) in comparison with the two other groups. We found a positive correlation between the male gender and termination of the motor block in patients receiving PNS-guided IBPB (group N) in comparison with two other groups. In our study, patients received satisfactory analgesia in the post-operational period no matter what technique was used regardless of their age, gender or potentially uncommon anthropometry.

Risk factors for the development of Horner's syndrome following interscalene brachial plexus block using ropivacaine for shoulder arthroscopy: a randomised trial.

Horner's syndrome is comprised of a set of symptoms caused by a permanent or transient ipsilateral sympathetic trunk lesion or paralysis. It may occur after numerous pathologies in the cervical region, epidural, spinal anaesthesia, and interscalene, transscalene, supraclavicular, or infraclavicular brachial plexus block. The aim of this randomised, prospective clinical study was to evaluate the effect of the interscalene brachial plexus block (IBPB) technique on the occurrence rate of Horner's syndrome and identify contributing risk factors. 108 randomly selected patients of ASA I-III status were scheduled for elective shoulder arthroscopy. The patients received 20 mL of 0.5% ropivacaine either with ultrasound (US)-guided IBPB (U), peripheral nerve stimulation (PNS)-confirmation IBPB (N), or US-guided, PNS-confirmed IBPB (dual guidance; NU). We observed that Horner's syndrome developed in 12% of the N group, 6% of the NU group, and 9% of the U group. The differences in the rates were not statistically significant (P = 0.616). Regardless of the technique used to induce IBPB, our study did not demonstrate any particular anthropometric parameter that predisposed the patients to the development of Horner's syndrome. Interestingly, our results showed that NU patients with Horner's syndrome were significantly younger than NU patients without Horner's syndrome. The precision of IBPB by use of the dual guidance technique may reduce the rate of Horner's syndrome. The higher water concentration in the prevertebral spaces of younger patients may create better conditions for the diffusion of ropivacaine, which may result in a statistically significant higher HS rate.

Reduced Hemidiaphragmatic Paresis With a "Corner Pocket" Technique for Supraclavicular Brachial Plexus Block: Single-Center, Observer-Blinded, Randomized Controlled Trial.

Hemidiaphragmatic paresis is common after supraclavicular brachial plexus block (SCBPB). In this randomized trial, we compared the incidence of hemidiaphragmatic paresis in patients who had local anesthetic injected primarily in the corner pocket (defined as the intersection of the first rib and subclavian artery) during SCBPB with that of patients who underwent injection primarily inside the neural cluster. Thirty-six patients scheduled for right elbow, forearm, wrist, or hand surgery under SCBPB (using 12.5 mL of 0.75% ropivacaine and 12.5 mL of 2% lidocaine with 1:200,000 epinephrine) were randomly assigned to 1 of 2 groups. In group CP, local anesthetic was injected primarily in the corner pocket (20 mL) and secondarily inside the neural cluster (5 mL). In group NC, local anesthetic was deposited primarily inside the neural cluster (20 mL) and secondarily in the corner pocket (5 mL). The primary outcome was the incidence of hemidiaphragmatic paresis, as measured by M-mode ultrasonography 30 minutes after SCBPB. The incidence of hemidiaphragmatic paresis was significantly lower in group CP than in group NC (27.8% vs 66.7%, P = 0.019). The median decreases in forced expiratory volume at 1 second (7.5% [interquartile range, 3.3%-17.1%] vs 24.4% [interquartile range, 10.2%-31.2%]; P = 0.010) and forced vital capacity (6.4% [interquartile range, 3.3%-11.1%] vs 19.3% [interquartile range, 13.7%-33.2%]; P = 0.001) were also lower in group CP than in group NC. The incidence of hemidiaphragmatic paresis was effectively reduced when local anesthetic was injected primarily in the corner pocket during right-sided SCBPB. However, the 28% incidence of hemidiaphragmatic paresis associated with the corner pocket technique may still represent a prohibitive risk for patients with preexisting pulmonary compromise. This study was registered at Clinical Trial Registry of Korea, identifier KCT0001769.

Henryk Hilarowicz: The Forgotten Polish Inventor and Pioneer of the Interscalene Brachial Plexus Block

Professor Henryk Hilarowicz was a Polish surgeon who first described the technique of brachial plexus block performed in the interscalene groove between the anterior and middle scalene muscles. The article devoted to the technique appeared in the German-language journal Zentralblatt für Chirurgie in 1925, 45 years before Alon Winnie, who is widely regarded as the originator of this method, published his paper in Anesthesia & Analgesia in 1970.

Inter Scalene Block: Revisiting old technique.

Background and Aims:The technique of percutaneous brachial plexus block has persisted in many variations since first such block given by Hirsheli in 1911.[1] Both supraclavicular and infraclavicular approaches have been described. Consequent to perivascular technique (Winnie and Collins 1964), Winnie described interscalene block (ISB) in 1970.[23] Winnie's was a single deposit block which relied upon volume for its success. It is nearly 50 years that ISB has stood the test of time and has evolved from single to multiple deposits Block. In mid-90s, ultrasound guidance was first explored by anesthetists for regional anesthesia in University of Vienna.[3] As ultrasound guidance is becoming popular and is increasingly available to budding anesthetist, popularity of old technique has started waning. In this study, old technique of ISB was revisited with a view to assess its success rate with established drugs and examine if in light of ultrasound guidance, this technique has become irrelevant for anesthetist today.Methods:A retrospective study, a survey with high response rate, was done on success rate of three variations of old technique of ISB in 100 patients. In variation-1, thirty patients received two deposits of local anesthetic in interscalene groove. In variation-2, thirty patients received four deposits of local anesthetic in interscalene groove. In variation-3, forty patients received six deposits of local anesthetic in interscalene groove along with infiltration of both scalene muscles. In none of the variations, paraesthesia was sought or peripheral nerve stimulator (PNS) or imaging gadget was used. Demographic data in three variations were compared statistically using Chi-square and one-way ANOVA test. Success rate among variations was analyzed by Fisher's exact test.Results:In variation-1, 17 out of 30, in variation-2, 23 out of 30, and in variation-3, 37 out of 40 blocks were successful.Conclusion:Success of ISB given without PNS or ultrasound guidance is directly proportional to the number of deposits of local anesthetic made in interscalene groove.

Randomized prospective study of three different techniques for ultrasound-guided axillary brachial plexus block

IntroductionRandomized prospective study comparing two perivascular techniques with the perineural technique for ultrasound-guided axillary brachial plexus block (US-ABPB). The primary objective was to verify if these perivascular techniques are noninferior to the perineural technique. Method240 patients were randomized to receive the techniques: below the artery (BA), around the artery (AA) or perineural (PN). The anesthetic volume used was 40mL of 0.375% bupivacaine. All patients received a musculocutaneous nerve blockade with 10mL. In BA technique, 30mL were injected below the axillary artery. In AA technique, 7.5mL were injected at 4 points around the artery. In PN technique, the median, ulnar, and radial nerves were anesthetized with 10mL per nerve. ResultsConfidence interval analysis showed that the perivascular techniques studied were not inferior to the perineural technique. The time to perform the blockade was shorter for the BA technique (300.4±78.4s, 396.5±117.1s, 487.6±172.6s, respectively). The PN technique showed a lower latency time (PN – 655.3±348.9s; BA – 1044±389.5s; AA – 932.9±314.5s), and less total time for the procedure (PN – 1132±395.8s; BA – 1346.2±413.4s; AA – 1329.5±344.4s). BA technique had a higher incidence of vascular puncture (BA – 22.5%; AA – 16.3%; PN – 5%). ConclusionThe perivascular techniques are viable alternatives to perineural technique for US-ABPB. There is a higher incidence of vascular puncture associated with the BA technique.

A comparison of ultrasound versus paresthesia technique for supraclavicular brachial plexus block

Background: Ultrasonography is a newer tool for identification of nerves in the practice of regional anaesthesia. Visualization of target structures and spread of drugs under direct vision and thus avoiding complications like pneumothorax, accidental intravascular injections are potential benefit of ultrasonography technique. Aim of the study was to examine the usefulness of ultrasound guided brachial plexus block and compare it with paresthesia technique with the believe that ultrasound guidance can shorten the onset as well as increase the duration of blockade..Methods: Eighty patients of either sex, 18-60 years, posted for upper limb surgery were divided into 2 groups according to the technique used to give block, group US (ultrasound technique) and group PA (paresthesia technique). Both the groups received 0.5 % bupivacaine 20 ml with 8 mg of dexamethasone.Results: There was notable difference between the patient groups with regard to initiation of motor blockade (10 min group US vs 11.1 min group PA, p &lt;0.0156) and sensory blockade (5.16 min group US vs 6.96 min group PA, p &lt;0.0001) also duration of motor blockade (1272.88 min in group US vs 899.25 min in group PA, p &lt;0.0001) and sensory blockade (1343.88 min in group US vs 996.75 min in group PA, p&lt;0.0001).Conclusions: Ultrasound guided supraclavicular brachial plexus blocks result in a higher success rate with respect to onset and duration of blockade with less incidence of complications compared to paresthesia technique.

Ultrasound-guided retroclavicular approach infraclavicular brachial plexus block for upper extremity emergency procedures

The America Society of Anesthesiology guidelines recommend multimodal analgesia that combines regional anesthetic techniques with pharmacotherapy to improve peri-procedural pain management and reduce opioid related complications. Commonly performed emergency procedures of the upper extremity such as fracture and dislocation reduction, wound debridement, and abscess incision and drainage are ideal candidates for ultrasound-guided (USG) regional anesthesia of the brachial plexus. However, adoption of regional anesthesia by emergency practitioners has been limited by concerns for potential complications and perceived technical difficulty. The Retroclavicular Approach to The Infraclavicular Region (RAPTIR) is a newly described USG brachial plexus block technique that optimizes sonographic needle visualization as a means of making regional anesthesia of the upper extremity safer and easier to perform. With RAPTIR a single well-visualized injection distant from key anatomic neck and thorax structures provides extensive upper extremity anesthesia, likely reducing the risk of complications such as diaphragm paralysis, central block, nerve injury, vascular puncture, and pneumothorax. Additionally, patient positioning for RAPTIR is well suited for the awake, acutely injured ED patient as the upper extremity remains adducted in a position of comfort at the patient's side. Thus, RAPTIR is a potentially ideal combination of infraclavicular targeting, excellent needle visualization, single injection, safety, comprehensive upper extremity analgesia, rapid performance, and comfortable patient positioning. Herein we present the first description of the RAPTIR utilized in the ED. Our initial experience suggests this is a promising new technique for brachial plexus regional anesthesia in the ED setting.

Ultrasound-Guided Costoclavicular Brachial Plexus Block: Sonoanatomy, Technique, and Block Dynamics.

This study aimed to describe in detail the relevant sonoanatomy, technique, and block dynamics of an ultrasound-guided costoclavicular brachial plexus block (BPB). Thirty patients scheduled for hand or forearm surgery under a BPB underwent transverse ultrasound imaging of the medial infraclavicular fossa to identify the cords of the brachial plexus at the costoclavicular space (CCS). An ultrasound-guided BPB was then performed at the CCS with 20 mL of 0.5% ropivacaine. Sensory-motor blockade of the ipsilateral median, radial, ulnar, and musculocutaneous nerves were assessed at regular intervals for 30 minutes after the injection. Successful block was defined as being able to complete surgery under the BPB. The CCS was visualized as a well-defined intermuscular space lying deep and posterior to the mid-point of the clavicle. The cords of the brachial plexus were clustered together lateral to the axillary artery within the CCS. The costoclavicular BPB was successfully performed in all patients, and the median onset time for sensory and motor blockade of all the 4 nerves was 5 [5-15] and 5 [5-10] minutes, respectively. Complete sensory blockade of all the 4 nerves was achieved in 30 [20-30] minutes, and the BPB was successful in 29 (97%) of 30 patients. There were no complications directly related to the technique or the local anesthetic injection. This report describes a novel technique of infraclavicular BPB at the costoclavicular space that produces rapid onset of BPB. Future research should compare the safety and efficacy of this new technique with the traditional lateral sagittal infraclavicular BPB.

Efficacy of Adding Midazolam to Bupivacaine in Supraclavicular Technique of Brachial Plexus Block for Upper Limb Surgeries

Efficacy of Adding Midazolam to Bupivacaine in Supraclavicular Technique of Brachial Plexus Block for Upper Limb Surgeries

Low Concentration Brachial Plexus Block Technique which Makes Possible Intraoperative Active Motion at the Time of Tendon Suture

Low Concentration Brachial Plexus Block Technique which Makes Possible Intraoperative Active Motion at the Time of Tendon Suture

Plexo Braquial y Vaina Axilar: Variante Anatómica y su Importancia Clínica

El éxito de la técnica anestésica del bloqueo del plexo braquial a nivel axilar radica en el conocimiento de la localización de cada uno de sus nervios periféricos o terminales, pero sobre todo, la relación que guardan los cordones lateral, medial y posterior con la arteria y vena axilar dentro de la vaina axilar. En el laboratorio de anatomía macroscópica humana de la Universidad Nacional Autónoma de Honduras en el Valle de Sula (UNAH-VS) encontramos dos variantes anatómicas de los componentes del plexo braquial en su relación circundando la arteria axilar. La primera variante se encontró al disecar el miembro superior derecho, en este, la arteria axilar se localiza anterior al nervio mediano emergiendo entre los ramos lateral y medial constitutivos de éste. La segunda variante se encontró al disecar el miembro superior izquierdo del mismo cadáver en el cual, la arteria axilar se localiza completamente anterior. Es por esto que se recomienda tener presente la existencia de estas variantes anatómicas para tener éxito al momento de realizar un bloqueo del plexo braquial a nivel axilar.Rev. Cient. Esc. Univ. Cienc. Salud, Vol.1(1) 2014: 29-32

Evidence Base for the Use of Ultrasound for Upper Extremity Blocks: 2014 Update.

This article reviews and summarizes randomized, controlled studies that have assessed ultrasound (US) guidance for brachial plexus blocks in comparison with other nerve localization methods as well as those that have compared different US-guided brachial plexus block techniques. Both PubMed and EMBASE databases were searched using the MeSH terms anesthetic technique, brachial plexus, and ultrasound. Studies were included if they had randomized allocation comparing US with another conventional nerve localization technique or if they compared 2 different US-guided techniques, such as single versus multiple injections. Each study was classified as a categorical outcome as being supportive, unclear, or negative for the use of US. These were compared with χ analysis with the null hypothesis that US provides no benefit for brachial plexus blocks. Forty-seven studies met the inclusion criteria, and 29 compared US guidance to landmark or peripheral nerve stimulation techniques. Our analysis of the literature supports the use of US over other nerve localization techniques as being beneficial for several block performance outcomes including block performance time, reducing the number of needle passes and the incidence of vascular puncture, shortening sensory block onset time, and improving block success.