A Novel Infraclavicular Brachial Plexus Block: The Lateral and Sagittal Technique, Developed by Magnetic Resonance Imaging Studies

Klaastad, Øivind; Smith, Hans‐Jørgen; Smedby, Örjan; Winther-Larssen, Eldrid H.; Brodal, Per; Breivik, Harald; Fosse, Erik

doi:10.1213/01.ane.0000094337.75996.ae

Cited by 86 publications

(35 citation statements)

References 14 publications

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“…At our institution, the preferred technique for ultrasound guided infraclavicular brachial plexus block is similar to that described by Sandhu et al 7 and Klaastad et al 8 Patients were placed supine with the arm abducted at 90°. Standard monitors were applied, and after the placement of an intravenous catheter, midazolam 2 mg iv and fentanyl 50 ug iv were administered.…”

Section: Methodsmentioning

confidence: 99%

Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks

Morimoto

Popović

Kim

et al. 2007

Can J Anesth/J Can Anesth

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Purpose: To ultrasonically identify the presence of septae within the neurovascular sheath and to assess their effect on local anesthetic spread when performing infraclavicular brachial plexus blocks.Clinical features: Thirty ASA status I and II patients scheduled for minor hand surgeries were enrolled in the study. Ultrasound guided infraclavicular brachial plexus blocks were performed on 28 patients. The images of the local anesthetic spread and the effect of the septum within the neurovascular sheath were analyzed. Septae were present in four of six patients where unilateral local anesthetic spread was seen. Septae were not visualized in the 22 patients with unrestricted local anesthetic spread after the initial injection. All 28 patients underwent their planned operations successfully with adequate anesthesia. Conclusions:Our study shows that the presence of septae within the neurovascular sheath may influence the pattern of local anesthetic spread associated with the infraclavicular approach to brachial plexus blocks. A previous cadaveric study revealed that a compartmentalized neurovascular sheath, and uneven distribution of local anesthetic around the nerve components of the plexus may be associated with failed and partial blocks. 1,2 With the use of nerve stimulators, the success rate of the single injection technique was as low as 44%, especially when only the lateral cord was stimulated. [3][4][5][6] We hypothesized that ultrasonographic identification of septae may be beneficial in performing infraclavicular brachial plexus blocks. The purpose of this study was to ultrasonically identify the presence of septae within the neurovascular sheath and to assess their possible effect on local anesthetic spread.

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Section: Methodsmentioning

confidence: 99%

Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks

Morimoto

Popović

Kim

et al. 2007

Can J Anesth/J Can Anesth

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“…İnfraklavikuler blok, Klaastad ve ark.nın [9] önerdiği lateral sagittal infraklaviküler blok (LSİB) tekniği-ne göre yapıldı. Hastalar sırt üstü pozisyonda omuz gevşek, cerrahi uygulanacak ekstremite dirsekten 90 derece açı ile bükülerek el gövde üzerine alındı ve hastanın başı hafifçe blok uygulanacak tarafın tersi yönde çevrildi.…”

Section: Blok Tekniğiunclassified

Comparison of Ultrasound guided supraclavicular and infraclavicular approaches for brachial plexus blockade.

Gürkan¹,

Hoşten²,

Tekïn³

et al. 2012

Agri

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SummaryObjectives: Ultrasound-guided supraclavicular and infraclavicular blocks are commonly used for upper extremity surgery. The primary aims of our study were to compare block success, block onset times and performance times; secondary aims were to compare the number of needle advancements, and incidence of adverse events of ultrasound-guided supraclavicular or infraclavicular blocks. Methods: 110 patients were randomized into two groups: supraclavicular (Group S) and infraclavicular (Group I). All the patients were given a mixture of 20 ml 0.5% levobupivacaine and 10 ml 2% lidocaine as local anesthetics. The sensory score of the seven terminal nerves was assessed every 10 min for 30 min. Results: Block success (Group I: 92.7%; Gorup S: 83.6%) and block onset time (Group I: 12.5±4.8; Group S: 11.6±3.9 min) were similar between the groups. Block performance time was shorter in Group I, than Group S (194.4±65; 226.3±59 sec, P<0.05 ÖzetAmaç: Ultrason rehberliğinde yapılan supraklaviküler ve infraklaviküler bloklar üst ekstremite cerrahisinde sıklıkla uygulanmaktadır. Bu çalışmanın birinci amacı ultrason rehberliğinde yapılan supraklaviküler ve infraklaviküler blokların, blok başarısı, blok başlama zamanı ve blok uygulama zamanının, ikinci amacı ise iğne yönlendirme sayısının ve istenmeyen yan etkilerin görülme sıklığının karşılaştırılmasıydı.Gereç ve Yöntem: Hastalar (n=110) supraklaviküler (Grup S) ve infraklaviküler (Grup İ) olmak üzere iki gruba ayrıldı. Lokal anestezik olarak tüm hastalara 20 ml %5'lik levobupivakain ve 10 ml %2'lik lidokain karışımı uygulandı. Duyu skoru yedi terminal sinirde 30 dk boyunca her 10 dk da bir olarak değerlendirildi. Bulgular: Gruplar arasında blok oluşma süresi (Grup İ: 12.5±5; Grup S: 11.6±4 dk) ve blok başarısı (Grup İ: %92.7; Grup S: %83.6) benzerdi. Blok uygulama süresi Grup İ' de Grup S' den anlamlı derecede kısaydı (194.4±65; 226.3±59 sn) (p<0.05) İğne yönlendirme sayısı Grup İ' de Grup S' den anlamlı derecede azdı (p<0.05). Grup İ' deki hastalarda ulnar ve median sinirlerin blokajı Grup S' deki hastalardan, Grup S' deki hastalarda ise medial kutanöz sinirin blokajı Grup İ' dekilerden anlamlı derecede başarılı idi (p<0.05). Grup S' de 9 hastada (%16.3) Horner sendromu, bir hastada (%1.8) parestezi görüldü. Sonuç:İnfraklaviküler ve supraklaviküler yaklaşımla blok özellikleri benzer bulunmuştur ancak infraklaviküler yaklaşım geçici yan etkilerinin daha az olması nedeniyle supraklaviküler bloğa tercih edilebilir.Anahtar sözcükler: Horner sendromu; infraklaviküler brakiyal pleksus bloğu; pnömotoraks; supraklaviküler brakiyal pleksus bloğu.

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“…We hypothesized that ultrasound guidance increases the success rate of infraclavicular block from 68% [1][2][3][4][5][6] to 90% compared with a dual endpoint stimulation technique. Assuming a = 0.05 and b = 0.2 required a sample size of 106 patients (53 per group).…”

Section: Discussionmentioning

confidence: 99%

“…While various nerve stimulator-guided approaches to infraclavicular block have been described in the literature, [1][2][3][4][5][6] success rates reportedly range from only 60 to 79%. The highest success rate is associated with multiple-cord stimulation, 3,5,6 such that the elicitation of motor twitches corresponding to at least two cords (i.e., dual motor endpoint) is the most reliable goal for traditional nerve stimulator-guided infraclavicular block.…”

Section: Résumémentioning

confidence: 99%

Compared with dual nerve stimulation, ultrasound guidance shortens the time for infraclavicular block performance

Brull

Lupu

Perlas

et al. 2009

Can J Anesth/J Can Anesth

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Purpose The success rate for infraclavicular brachial plexus block using nerve stimulation reportedly ranges from 60 to 80%. Ultrasound guidance may be associated with greater success. This study compared ultrasound guided infraclavicular block with a dual motor endpoint nerve stimulation technique. Methods One hundred three hand surgery patients were randomized to receive either ultrasound-guided (ultrasound group) or dual motor endpoint nerve stimulation (stimulation group) infraclavicular block using 2% lidocaine 15 mL and 0.5% bupivacaine 15 mL with epinephrine. Block success was defined as loss of sensation to pinprick in each of the radial, ulnar, median, and musculocutaneous nerve distributions when measured 20 min after block performance. Block performance time, readiness for surgery (no supplemental block, skin infiltration, or general anesthesia), and complications were also assessed.Results Patient characteristics were similar between groups. Success rate was 92% in the ultrasound group and 80% in the stimulation group (P = 0.18). Block performance time was shorter in the ultrasound group (median 5 min) compared with the stimulation group (median 10.5 min) (P \ 0.001). Paresthesiae were more frequent in the stimulation group (45%) than in the ultrasound group (6%) (P \ 0.001). After final injection, more patients were ready for surgery in the ultrasound group (85%) than in the stimulation group (65%) (P = 0.04). At 1 week postoperatively, complications were minor and transient and did not differ between groups. Conclusion There was no statistically significant difference in the success rate between ultrasound guidance and dual motor endpoint stimulation for infraclavicular block. However, ultrasound guidance shortens performance time and improves readiness for surgery compared with dual motor endpoint stimulation (Clinical Trial Registration Number: NCT00326261). RésuméObjectif Selon la litte´rature, le taux de re´ussite d'un bloc infraclaviculaire du plexus brachial re´alise´par stimulation nerveuse se situe entre 60 % et 80 %. L'e´choguidage pourrait eˆtre associe´a`un taux de re´ussite plus e´leve´. Cette e´tude a compare´un bloc infraclaviculaire re´alise´par e´choguidage a`une technique de double stimulation nerveuse des extre´mite´s motrices. Méthode Cent-trois patients devant subir une chirurgie de la main ont e´te´randomise´s à recevoir un bloc infraclaviculaire re´alise´soit par e´choguidage (groupe e´choguidage) ou par double stimulation nerveuse des extre´mite´s motrices (groupe stimulation) a`l'aide de 15 mL de lidocaı¨ne 2 % et de 15 mL de bupivacaı¨ne 0,5 % avec e´pine´phrine. La re´ussite du bloc a e´te´de´finie en tant que la

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A Novel Infraclavicular Brachial Plexus Block: The Lateral and Sagittal Technique, Developed by Magnetic Resonance Imaging Studies

Cited by 86 publications

References 14 publications

Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks

Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks

Comparison of Ultrasound guided supraclavicular and infraclavicular approaches for brachial plexus blockade.

Compared with dual nerve stimulation, ultrasound guidance shortens the time for infraclavicular block performance

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