Vertical Infraclavicular Brachial Plexus Block Research Articles

A study of phrenic nerve paralysis after vertical infraclavicular brachial plexus block

A study of phrenic nerve paralysis after vertical infraclavicular brachial plexus block

“Vertical infraclavicular block with Dexmeditomidine as an adjuvant to local anesthetics-multifaceted quality enhancement effort”

Introduction: For regional anesthesia, various adjuvants have been used along with local anesthetics (LA). We studied the effect of addition of Dexmeditomidine to LA in vertical infraclavicular brachial plexus block (ICB). The primary goal was to study the onset and duration of sensory and motor block. The secondary goal was to note the time for first rescue analgesic and quality of block. Materials and Method :Sixty patients ( 18 to 60 years) posted for below elbow orthopaedic surgeries were given vertical ICB using PNS, after computerized randomization into two equal groups: Group S: Bupivacaine 0.375% (18 cc) + lignocaine 1.5% 20 cc + 2cc normal saline. Group D: Bupivacaine 0.375% (18 cc) + lignocaine 1.5% 20cc +dexmedetomidine 1 ?g/kg (2ml volume). All the patients were observed for onset of sensory and motor block, total sensory and motor block duration, time to first rescue analgesic and side effects if any. Results: The demographic data in two groups was statistically comparable. The onset of sensory and motor block in Group D was faster (p

A comparison of infraclavicular and supraclavicular approaches to the brachial plexus using neurostimulation

BackgroundA prospective, double blind study was performed to compare the clinical effect of vertical infraclavicular and supraclavicular brachial plexus block using a nerve stimulator for upper limb surgery.MethodsOne hundred patients receiving upper limb surgery under infraclavicular or supraclavicular brachial plexus block were enrolled in this study. The infraclavicular brachial plexus block was performed using the vertical technique with 30 ml of 0.5% ropivacaine. The supraclavicular brachial plexus block was performed using the plumb bob technique with 30 ml of 0.5% ropivacaine. The block performance-related pain was evaluated. This study observed which nerve type was stimulated, and scored the sensory and motor block. The quality of the block was assessed intra-operatively. The duration of the sensory and motor block as well as the complications were assessed. The patient's satisfaction with the anesthetic technique was assessed after surgery.ResultsThere were no significant differences in the block performance-related pain, frequency of the stimulated nerve type, evolution of sensory and motor block quality, or the success of the block. There were no significant differences in the duration of the sensory and motor block. There was a significant difference in the incidence of Horner's syndrome. Two patients had a pneumothorax in the supraclavicular approach. There were no significant differences in the patient's satisfaction.ConclusionsBoth infraclavicular and supraclavicular brachial plexus block had similar effects. The infraclavicular approach may be preferred to the supraclavicular approach when considering the complications.

Vertical Infraclavicular Brachial Plexus Block

In vertical infraclavicular brachial plexus block, success depends on distal flexion or extension response. Initially, elbow flexion (lateral cord) is generally observed. However, specific knowledge about how to reach the medial or posterior cord is lacking. We investigated the mid-infraclavicular area in undisturbed anatomy and tested the findings in a clinical setting. Along a length of 35 mm around the mid-infraclavicular point, cryomicrotomy sections of 5 shoulders from cadavers were used to determine the topography of the cords in relation to one another and the axillary artery. Based on the findings, the anesthesiologists were instructed on how to elicit a distal motor response after an initial elbow flexion response in single-shot, Doppler-aided, vertical infraclavicular block in a series of 50 consecutive patients. In the mid-infraclavicular area, the lateral cord always lies anterior to either the posterior or the medial cord and cranial to the axillary artery; the posterior cord was always cranial to the medial cord; and both cords were always located dorsal to the artery. In the clinical study, in 98% of the included patients, finger flexion or finger and/or wrist extension was elicited as predicted. The overall success rate was 92%. No vascular or lung puncture occurred. In the clinical study, in 98% of cases, the final stimulation response of posterior or medial cord was found as predicted by the findings of the anatomic study. Once elbow flexion is elicited, a further (ie, deeper) advancement of the needle will result in the proper distal motor response.

Comparison of vertical infraclavicular brachial plexus block with 0.5% levobupivacaine and 0.5% ropivacaine for upper limb surgery.

We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.5% levobupivacaine and 0.5% ropivacaine for upper limb surgery. We included 60 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.5% levobupivacaine or 0.5% ropivacaine. We observed which nerve type was stimulated and scored the sensory and motor block. The quality of block was assessed intraoperatively. The duration of sensory and motor block and complications were assessed. There were no significant differences in frequencies of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant difference in duration of sensory block, but duration of motor block was prolonged after 0.5% levobupivacaine. There were no complications. Both 0.5% levobupivacaine and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block.

A clinical comparison of vertical infraclavicular brachial plexus block using 0.75% or 0.5% ropivacaine for upper limb surgery.

We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.75% vs 0.5% ropivacaine for upper limb surgery. We included 80 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.75% or 0.5% ropivacaine. By observation, we determined nerve type was stimulated and scored the level of sensory block and motor block. The quality of blocks was assessed intra-operatively. The duration of sensory block and motor block and their complications were assessed. There were no significant differences in the frequency of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant differences in the duration of sensory block and motor block. Vascular puncture was noted in 1 patient in the 0.75% ropivacaine. Both the 0.75% and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block.

The Influence of Arm Abduction on the Anatomic Relations of Infraclavicular Brachial Plexus: An Ultrasound Study

Distances from brachial plexus to the coracoid process and the pleura are critical for performing infraclavicular block. We evaluated the influence of arm abduction on the position of the neurovascular bundle relative to the skin, to the coracoid process and to the pleura using ultrasonography. An ultrasound examination of the brachial plexus at the infraclavicular level was performed on 26 patients. Distances from the axillary artery to the skin, to the coracoid process and to the pleura were measured and noted with different degrees of arm abduction (0 degrees , 45 degrees , and 90 degrees ). Vertical infraclavicular brachial plexus block was then performed by means of nerve stimulation in 14 additional patients undergoing hand surgery. Under ultrasound examination, the distance from the axillary artery to the skin was found to be significantly less with arm abduction (0 degrees : 32 +/- 7 mm, 45 degrees : 29 +/- 7 mm, 90 degrees : 25 +/- 5 mm, P < 0.05). The distance from the skin to the pleura was 47 +/- 5 mm with a medial deviation of 18 +/- 3 degrees and was not influenced by arm position. Brachial plexus was identified by nerve stimulation at a vertical depth of 41 +/- 7 mm from the skin. Abduction of the arm reduces the depth of the brachial plexus but does not change the position of the axillary artery relative to the coracoid process or the pleura. Ultrasonography may under-estimate the actual depth of the plexus.

The Vertical Infraclavicular Brachial Plexus Block: A Simulation Study Using Magnetic Resonance Imaging

The recommended needle trajectory for the vertical infraclavicular brachial plexus block is anteroposterior, caudad to the middle of the clavicle. We studied the risk of pneumothorax and subclavian vessel puncture and the precision of this method by using magnetic resonance imaging in 20 adult volunteers. The trajectory aimed at the lung in six subjects, five of whom were women. However, pleural contact could be avoided in all subjects by halting needle advancement after contact with the subclavian vessels, plexus, or first rib. The subclavian vein was reached by the trajectory in three and the subclavian artery in five subjects. The trajectory had a median distance to the plexus (closest aspect) of 1 mm (range, 0-9 mm) and contacted the nerves in 9 subjects. In conclusion, there is a small probability that the needle may reach the pleura when a vertical infraclavicular brachial plexus block is performed, particularly in women, and a high probability that it will contact the subclavian vein or artery. Although the trajectory is close to the plexus, any medial deviation carries the risk of pleural or subclavian vessel contact at other depths. Clinical accuracy in defining the insertion point is critical.

Vertical infraclavicular brachial plexus block in children: a preliminary study

Vertical infraclavicular brachial plexus block in children: a preliminary study

Vertical infraclavicular brachial plexus block in children: a preliminary study

Brachial plexus blockade is a well-established technique in upper limb surgery. Among the infraclavicular approaches, the vertical infraclavicular brachial plexus (VIP) block is easy to perform and has a large spectrum of nerve blockade. The aim of this preliminary study was to determine the ease, effectiveness, safety, and duration of the VIP block in pediatric trauma surgery. Fifty-five patients (ASA physical status I and II, age range 5-17 years old) scheduled for upper limb trauma surgery received a VIP block under light general anesthesia, using 0.5 ml x kg(-1) of ropivacaine 0.5%. The number of attempts and time to perform the block, the occurrence of a surgical response, the visual analogue score (VAS) scores, the incidence of complications and the duration of the block were evaluated. The brachial plexus was found easily at the first or second attempt in 85% (47 of 55) of the cases, in 15% (eight of 55) of the cases it was localized after three to four attempts. The mean time to perform the block was 3.35 +/- 3.37 min. Ninety-eight percentage (54 of 55) of the blockades were effective for surgery and in just one case was ineffective. The VAS scores at the end of the procedure in 100% (55 of 55) of the cases were <3. There were no cases with clinical signs of pneumothorax nor inadvertent puncture of major vessels. Two patients developed a Horner's syndrome and in one a mild superficial hematoma at the puncture site occurred. The mean sensory block duration was 8.45 +/- 1.71 h and the mean motor block duration was 6.52 +/- 2.50 h. In this preliminary study, the VIP block was easy to perform, effective and free of major complications for pediatric trauma surgery. With the doses of ropivacaine we used it was useful for intra- and postoperative analgesia.