Anatomical variations of interscalene brachial plexus block: Do they really matter?

Yadav, Naveen; Saini, Navdeep; Ayub, Arshad

doi:10.4103/1658-354x.125981

Cited by 5 publications

(7 citation statements)

References 4 publications

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“…In a case report by Chin et al, a patient with a C5 root located medial to the anterior scalene muscle (ASM) and a C6 root located in the inferomedial was reported [3]. In addition, in another case report performed by Yadav et al, most of the roots originating from the ventral rami were emphasized to be stacked medial to the ASM [15]. This variation, rarely reported so far, was encountered in two (1.8%) patients in our study.…”

Section: Discussionmentioning

confidence: 99%

Anatomical variations detected during ultrasound-guided interscalene brachial plexus block and clinical implications

Kılıçaslan

Gök

Korucu

et al. 2020

Marmara Medical Journal

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Objective: Our aim was to evaluate the anatomic variations detected during ultrasound-guided interscalene brachial plexus block (US-ISB) and present their clinical implications. Materials and Methods: After the ethical approval for the study was obtained from the local ethics committee, the files and US records of patients who underwent US-ISB for anesthesia of the shoulder surgery were retrospectively analyzed. Results: Anatomical variations which were considered to affect the block technique were detected in 13 (11.8%) of 110 patients. C5 cervical root pierced the anterior scalene muscle (ASM) in 4.5%, and ventral rami of C5 and/or C6 were located in ASM in 3.6% of patients. There was a muscle bridge between C5 to C6 and C5 to C7 roots in 1.8% of the patients. The brachial plexus was located medial to ASM and missing from interscalene groove in 1.8% of patients. In one case (C5 root was located in ASM), US-ISB resulted in incomplete brachial plexus anesthesia, and so general anesthesia (GA) was performed. Conclusion: Some of the brachial plexus variations in the interscalene area may be associated with further needle manipulation/ redirection and block failure. We consider that prospective studies including more populations are needed to elucidate the effects of these variations on block parameters.

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Section: Discussionmentioning

confidence: 99%

Anatomical variations detected during ultrasound-guided interscalene brachial plexus block and clinical implications

Kılıçaslan

Gök

Korucu

et al. 2020

Marmara Medical Journal

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“…Other positions, such as all of the roots passing anterior to the scalene muscles, have also been reported in case reports. [11] Natsis et al [10] observed the incidence of the [7] [Color figure can be viewed in the online issue, which is available at www.anatomy.org.tr] Anatomy • Volume 13 / Issue 1 / April 2019 superior trunk passing anterior to, or through the anterior scalene as 2.2% and 6.5%, respectively. In a study from the United States, Leonhard et al [18] reported that the superior trunk pierced the muscle in 33.3% of individuals, while the middle trunk showed this position in only one side.…”

Section: Discussionmentioning

confidence: 99%

“…[3,4] Although the roots and trunks of the brachial plexus are described as being located in the interscalene groove in anatomical textbooks, [1] several authors have reported variant positions of these nerves in relation to the scalene muscles. [5][6][7][8][9][10][11] In a dissection study, Harry et al [7] observed the standard position of the roots in the interscalene groove in only 35% of individuals, of which most were bilateral, suggesting that variation is common. Variant patterns may consist of the C5 and C6 roots passing anterior to the scalene muscle or even through the muscle belly, either individually or coursing together.…”

Section: Introductionmentioning

confidence: 99%

Variation of the brachial plexus roots in the interscalene groove: relevance in interscalene blocks

Keet¹,

Louw²

2019

Anatomy

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Objectives: The interscalene block is utilized for regional anesthesia of the upper limb, targeting the roots and trunks of the brachial plexus in the interscalene groove. The prevalence of variation, which may affect the success of this block, has not been documented in detail with respect to side and sex, nor has a classification system been proposed. Methods: Seventy-nine embalmed bodies were dissected bilaterally. The position of the roots and the subclavian artery relative to the anterior scalene muscle was documented and variations were classified according to prevalence. Differences in the prevalence of variation between left and right sides and between males and females were investigated. Results: The standard position of the nerves and subclavian artery in the interscalene groove (Type 1) was present in 31.6%. Variant positions included the following passing through the belly of the anterior scalene: C5 and C6 roots (Type 2) (46.8%), C5 root (Type 3) (15.2%), C5 and C6 roots as well as the subclavian artery (Type 4) (3.8%), and lastly, C5, C6 and C7 roots (Type 5) (2.5%). Variant anatomy was statistically more prevalent in females on the right side only. Conclusion: Variant locations of the roots and subclavian artery external to the interscalene groove were common, suggesting that ultrasound should be used to visualize variations prior to performing interscalene blocks. A classification type of variant positions has been developed for standardization.

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“…These muscles, in conjunction with the first rib, form the scalene triangle or interscalene triangle, through which the nerves and arteries of the brachial plexus transit. Moreover, the lung pleura and superior intercostal artery are positioned posterior to the anterior scalene [10] .…”

Section: Continuous Nerve Blockmentioning

confidence: 99%

Continuous Nerve Block

Khalil,

El-Sabagh,

Khashaba

2023

Benha Journal of Applied Sciences

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Background: CPNB known as "perineural infusion of local anesthetic" is the catheter placement next to a peripheral nerve, preceded by local anesthetic administration through catheter, which gives anesthesia/analgesia for many days or even months. CPNBs may be delivered in a hospital setting, but mobile infusion using mobile, lightweight pumps is also a possibility. The most prevalent use of this technique is postoperative pain control. Treating intractable hiccups is considered one of the included other indications; initiating vasodilation to raise blood supply and sympathectomy after catastrophic vascularity, digit transfer/replantation, or limb salvage; relieving Raynaud's disease vasospasm; and treating chronic pain and peripheral embolism, such as complex regional pain syndrome, phantom limb pain, trigeminal neuralgia, and cancer-induced pain. Perineural infusion may give analgesia after trauma while transit to a distant medical facility or while awaiting surgical repair. Catheter installation may be achieved utilizing various different methods, involving nerve stimulation, ultrasound guiding, paresthesia induction, fluoroscopic imaging, and basic tactile sensations ("facial click"). This article provides a review of the existing literature on continuous peripheral nerve blocks supported by evidence.

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Anatomical variations of interscalene brachial plexus block: Do they really matter?

Cited by 5 publications

References 4 publications

Anatomical variations detected during ultrasound-guided interscalene brachial plexus block and clinical implications

Anatomical variations detected during ultrasound-guided interscalene brachial plexus block and clinical implications

Variation of the brachial plexus roots in the interscalene groove: relevance in interscalene blocks

Continuous Nerve Block

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