Ultrasound-Guided Retroclavicular Block (aka Posterior Approach Infraclavicular Block)

Beh, Zhi Yuen; Hasan, Mohd Shahnaz; Lai, Hou Yee

doi:10.1097/aap.0000000000000456

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…Although the two approaches differ in direction of needle when injection of local anesthesiabut both approaches are considered proximal approaches to the ICBPB where the needle directed toward first part of axillary artery, the main concern with needletip visualization wasthe clavicle shadow before visualize needle at its trajectory to the target site in RCB while in PIBapproach the needle is well visualized throughout its whole lengthand this will avoid the penetration of the superficial pleura at this site, in our study no vascular or pleural injury noticed (7,15) . one case was planned to be given RCBbut we faced technical difficulties in insertion of the needle and directing it to the target of posterior cord due to morbid obesity, short neck and acutely angulated clavicle and we decide to use the other approach and it was successful this is also what was seen by Zhi Yuen Beh (16) .…”

Section: Discussionmentioning

confidence: 94%

A Comparison between Retro-Clavicular and Proximal Infraclavicular Approaches for Brachial Plexus Block for Anesthesia of the Upper Limb

Mohammed Sami Hassan,

Mohammad Asi Jabbar,

Mortada Abd Al-Hussian Jubara

2021

Indian Journal of Forensic Medicine & Toxicology

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Background: This comparative study hypothesize there are differences betweenultrasound guided retroclavicular and proximal infraclavicular approaches for brachial plexus block for surgeriesinvolving lower part of arm, elbow, forearm and hand with the use of tourniquet.Method: About 36 patients randomly allocated into 2 groups, first group block done through retro-clavicular approach (RCB) and the other group done by using proximalinfraclavicular block (PIB).In RCB group needle inserted posterior to the clavicle and directed posterior to the first part of axillary artery. In PIB needle inserted from lateral to medial after abduction of the arm more than 90° where the cords are clustered together.Results: Block performance time was (6.11±2.58) and (6.05±2.61) for RCB and PIB, respectively without significant difference (p= 0.94). The onset of sensory was (12.8±1.4) and (11±2.3) for RCB and PIB, respectively. For motor onset (17.4 ±2.3) and (15.3±3.3) and there is significant difference between both groups (p=0.009 and 0.04), respectively. There was no significant difference in block-related pain between the two groups (p=0.809) VRS for RCB was (1.41±0.712) and for PIB was (1.32±0.67). Tourniquetpain reported by the patientfor RCB was 1.24±0.56 and for PIB was 1.11±0.315, there is no significant difference between both groups (p=0.392) Conclusion: Ultrasound guided BPB by retro-clavicular and proximal approaches are with a comparable quality of surgical anesthesia for operations of the lower arm, elbow, forearm and hand with the use of tourniquet, the onset of surgical anesthesia is earlier for PIB, the RCB is preferred for patients who cannot abduct the arm.

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Section: Discussionmentioning

confidence: 94%

A Comparison between Retro-Clavicular and Proximal Infraclavicular Approaches for Brachial Plexus Block for Anesthesia of the Upper Limb

Mohammed Sami Hassan,

Mohammad Asi Jabbar,

Mortada Abd Al-Hussian Jubara

2021

Indian Journal of Forensic Medicine & Toxicology

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“…In none of the cadavers, the needle had touched the posterior aspect of the clavicle, a tendency of this approach as reported by Beh ZY et al . [ 18 ] Some authors have stated that by keeping the needle close to the under surface of the clavicle, the block needle passes through only muscle and loose connective tissue and avoids pneumothorax if not directed posteriorly. [ 2 7 ] Supraclavicular nerves too may be trespassed by this approach, unlike our dissection findings.…”

Section: Discussionmentioning

confidence: 99%

A cadaver study of four approaches of ultrasound-guided infraclavicular brachial plexus block

et al. 2020

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Background and Aims: The ultrasound-guided infraclavicular brachial plexus block (USG ICBPB) is a popular technique for forearm surgeries distal to the elbow. Our study details the ultrasound (US) characteristics of this block and the structures encountered by the needle in four approaches to the infraclavicular area – lateral infraclavicular (LICF), costoclavicular medial to lateral (CML) and lateral to medial (CLM) and retroclavicular (R) by anatomical dissection. Methods: USG ICBPB was performed in 10 cadavers—5 on the right side and 5 on the left side by each of four approaches and with an 18 gauge Tuohy needle kept in situ , and US characteristics were noted. Anatomical dissection was done and important structures were described in detail. Results: Needle tip and shaft visibility were least with LICF approach and best in R approach. Needle angle correlated with chest and neck circumference in LICF and CML groups. During dissection, in all approaches, neurovascular structures have been observed in the near vicinity of the needle, especially the thoracoacromial artery (TAA) or its branches. In the R approach, the 'blind spot' behind the clavicle is an area where neurovascular structures were present. Conclusion: The R approach gives better visibility of needle shaft beyond the clavicle, but the clavicle acts as a 'blind-spot' for the US beam obliterating important neurovascular structures. The various neurovascular structures the needle traverses or in its immediate vicinity, do not necessarily make the CML, CLM or R approach any better than the LICF approach.

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“…In one randomized trial (reported in correspondence form), the two approaches resulted in similar imaging/needling/performance times and success rates 5. However, these findings may be difficult to interpret due to the small sample size (n=46) and the lack of power analysis.…”

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confidence: 93%

Retroclavicular approach to infraclavicular brachial plexus block: a logical conundrum

Leurcharusmee

Layera

Finlayson

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Ultrasound-Guided Retroclavicular Block (aka Posterior Approach Infraclavicular Block)

Cited by 5 publications

References 5 publications

A Comparison between Retro-Clavicular and Proximal Infraclavicular Approaches for Brachial Plexus Block for Anesthesia of the Upper Limb

A Comparison between Retro-Clavicular and Proximal Infraclavicular Approaches for Brachial Plexus Block for Anesthesia of the Upper Limb

A cadaver study of four approaches of ultrasound-guided infraclavicular brachial plexus block

Retroclavicular approach to infraclavicular brachial plexus block: a logical conundrum

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