Ünase BÜYÜKKOÇAK, Hülya BAŞAR, Alpaslan APAN, Şaziye ŞAHİN

A novel approach for brachial plexus block

Aim: The line from the midpoint of the sternocleidomastoid muscle to the midpoint of the clavicle was considered the surface projection of the brachial plexus in the supraclavicular region in a previous report using radiological and anatomic techniques. The needle insertion site was the point between the clavicular one-third and cervical two-thirds of this line. The aim of the present study was to determine the clinical efficacy of these suggested landmarks. Materials and methods: Brachial plexus block was performed in 60 healthy adult patients undergoing elective surgery on an upper extremity using the above-mentioned new surface landmarks. Results: The characteristics of the block resemble those in the interscalene technique. Brachial plexus block was performed with a high success rate (98.5%) and minor complications including phrenic nerve palsy (45%), Horner syndrome (15%), and recurrent nerve block (1.6%). No major complication such as pneumothorax or accidental intravascular insertion was observed. Conclusion: The new landmarks were not dependent on patients’ physical features or deeper anatomic structures. The surface landmarks based on bony prominences were defined easily. Brachial plexus block was performed with a high success rate and is considered a safe alternative to the classically described techniques.

Anahtar Kelimeler:

Key words: Regional anesthesia, technique, brachial plexus block

A novel approach for brachial plexus block

Keywords:

Key words: Regional anesthesia, technique, brachial plexus block,

PDF

___

Winnie AP. Interscalene brachial plexus block. Anesth Analg 1970; 49: 455-66. 2. Winnie AP, Collins VJ. The subclavian perivascular technique of brachial plexus anesthesia. Anesthesiology 1964; 25: 353-63. 3. Raj PP, Montgomery SJ, Nettles D, Jankins MI. Infraclavicular brachial plexus block: A new approach. Anesth Analg 1973; 52: 897-902. 4. De Jong RH. Axillary block of the brachial plexus. Anesthesiology 1961; 17: 215-25. 5. Partrige BL, Katz J, Benirschke K. Functional anatomy of the brachial plexus sheath: Implications for anesthesia. Anesthesiology 1987; 66: 743-7.
Kapral S, Greher M, Huber G, Willschke H, Kettner S, Kdolsky R et al. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med 2008; 33: 253-8.
Sites BD, Spence BC, Gallagher JD, Beach M. On the edge of the ultrasound screen: regional anesthesiologists diagnosing nonneural pathology. Reg Anesth Pain Med 2006; 31: 555-62.
Apan A, Baydar Ş, Yılmaz S, Uz A, Tekdemir İ, Güney Ş et al. Surface landmarks of brachial plexus: ultrasound and magnetic resonance imaging for supraclavicular approach with anatomical correlation. Eur J Ultrasound 2001; 13: 191-6. 9. Kulenkampff D. Die anästhesierung des plexus brachialis. Dtsch Med Wochenschr 1912; 38: 1678-80.
Hickey R, Garland TA, Rammamurthy S. Subclavian perivascular block: Influence of location of paresthesia. Anesth Analg 1989; 68: 767-71.
Moorthy SS, Schmidt SI, Dierdorf SF, Rosenfeld SH, Anagnostou JM. A supraclavicular lateral paravascular approach for brachial plexus regional anesthesia. Anesth Analg 1991; 72: 241-4.
Fleck JW, Moorthy SS, Daniel J, Dierdorf SF. A comparison of the supraclavicular paravascular and axillary approaches. Reg Anesth 1994; 19: 14-7.
Klaastad Ø, Smedby Ö. The supraclavicular lateral paravascular approach for brachial plexus regional anesthesia: a stimulation study using magnetic resonance imaging. Anesth Analg 2001; 93: 442-6.
Kapral S, Krafft P, Eibenberger K, Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg 1994; 78: 507-13.
Pippa P. Brachial plexus block using a new subclavian perivascular technique: the proximal cranial needle approach. Eur J Anaesthesiol 2000; 17: 120-5.
Russon KE, Herrick MJ, Moriggl B, Messner HJ, Dixon A, Harrop-Griffiths W, et al. Interscalene brachial plexus block: assessment of the needle angle needed to enter the spinal canal. Anaesthesia 2009; 64: 43-5.
Vongvises P, Panijayanond T. A parascalene technique of brachial plexus anesthesia. Anesth Analg 1979; 58: 267-73.
Dupre LJ, Danel V, Legrand JJ, Stieglitz P. Surface landmarks for supraclavicular block of the brachial plexus. Anesth Analg 1982; 61: 25-31.
Dalens B, Vaneuville G, Tanguy A. A new parascalene approach to the brachial plexus in children: comparison with the supraclavicular approach. Anesth Analg 1987; 66: 1261-71.
Pham-Dang C, Gunst JP, Gouin F, Poirier P, Touchais S, Meunier JF et al. A novel supraclavicular approach to brachial plexus block. Anesth Analg 1997; 85: 111-6.
Brown DL, Cahill DR, Brindenbaugh LD. Supraclavicular nerve block: anatomic analysis of a method to prevent pneumothorax. Anesth Analg 1993; 76: 530-4.
Klaastadt Ø, VadeBoncouer TR, Tillung T, Smedby O. An evaluation of the supraclavicular plumb-bob technique for brachial plexus block by magnetic resonance imaging. Anesth Analg 2003; 96: 862-7.
Nyugen HC, Fath E, Wirtz S, Bey T. Transscalene brachial plexus block: a new posteriolateral approach for brachial plexus block. Anesth Analg 2007; 105: 872-5.