Assessment of variation in depth of brachial plexus using ultrasound for supraclavicular brachial plexus block in patients undergoing elective upper limb surgery

Mistry, Tuhin; Mangal, Vandana; Sharma, Gaurav; Agrawal, Ajay

doi:10.4103/0019-5049.183385

Cited by 6 publications

(9 citation statements)

References 10 publications

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“…In this context, comparative anatomy of the formation of the brachial plexus has been studied since the 19th century (Paterson 1887). The brachial plexus is a complex anatomical structure, from its origin to the neck and to its final branching in the axillary region (Fazan et al 2003), and remains one of the most intriguing themes of contemporary anatomy (Johnson et al 2010;Souza-Junior et al 2014;Mistry et al 2016;Shinn et al 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Knowledge on the anatomical characteristics and the variations of this plexus is an important ally in applied studies, and may make the diagnosis of neuromuscular dysfunctions easier (Freeman et al 2009). Besides, it may guide local and regional anaesthetic nerve block techniques, once these techniques lead to intraoperative analgesia for musculoskeletal structures of the thoracic limbs and the shoulders (Futema et al 1999;Mencalha et al 2014Mencalha et al , 2016Mistry et al 2016;Shinn et al 2016).…”

Section: Introductionmentioning

confidence: 99%

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Origin and antimeric distribution of brachial plexus nerves in Macaca mulatta (Zimmermann, 1780) (Primates: Cercopithecidae)

Santos-Sousa

Gomes

Carvalho

et al. 2016

Italian Journal of Zoology

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Morphology studies provide knowledge that allows us to understand how animals interact with their natural environment or in captivity. In this context, comparative anatomy on the formation of the brachial plexus has been a matter of interest since the 19th century, and remains one of the most intriguing topics of contemporary anatomy. The aim of this study was to describe the origin and the antimeric distribution of the brachial plexus nerves in Macaca mulatta, as well as the muscles innervated by it. Ten male rhesus monkeys (Macaca mulatta) were used. Animals came from the Laboratory Animals Breeding Centre (Cecal/Fiocruz), and were donated to the Animal Anatomy Department of the Universidade Federal Rural do Rio de Janeiro. Specimens were fixed in formaldehyde by infusion of a 10% solution. They were subsequently kept in low-density polythene containers with 500 L of 30% formaldehyde over a period of 12 months. In 11 plexus (55%) the resulting nerves were constituted by the connections between the ventral spinal branches C5, C6, C7, C8 and T1. In five plexus (25%), the participant roots were C4, C5, C6, C7, C8, T1 and T2. In two (10%) plexus, they were C5, C6, C7, C8, T1 and T2. In the other two (10%) plexus it was observed to be formed from C6, C7, C8, T1 and T2. The ventral branches formed three nerve trunks: cranial, middle and caudal. The suprascapular, subscapular, axillary, musculocutaneous, radial, median and ulnar nerves innervated the intrinsic muscles. The subclavian, thoracodorsal, medial cutaneous nerve of the arm and forearm, long thoracic, cranial pectoral and caudal pectoral innervated extrinsic muscles. Results obtained in this study contribute to the field of comparative anatomy of primates, and provide information for applied research, serving as a basis for clinical and surgical procedures that use this species as a model animal.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Origin and antimeric distribution of brachial plexus nerves in Macaca mulatta (Zimmermann, 1780) (Primates: Cercopithecidae)

Santos-Sousa

Gomes

Carvalho

et al. 2016

Italian Journal of Zoology

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“…Infraclavicular brachial plexus blocks and central venous cannulation of the axillary or subclavian veins are two common procedures performed in the infraclavicular fossa that require knowledge of the average depth of the nerves and vessels, as they involve accessing these structures through the skin. 1,2,14 The position of the axillary vein was unable to be determined in this case due to damage from a previous dissection, thus its relationship to pectoralis minor is unknown.…”

Section: Discussionmentioning

confidence: 96%

“…Brachial plexus blocks are a commonly performed alternative to general anaesthesia for surgical procedures involving the upper limb. 14 They are also commonly used in combination with general anaesthesia to provide intraoperative and postoperative analgesia. The various infraclavicular approaches to brachial plexus blocks are utilised for surgery on the elbow, forearm and hand and may be used as an alternative to supraclavicular blocks, which have a higher risk of complication, in particular accidental pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

Superficial location of the brachial plexus and axillary artery in relation to pectoralis minor: a case report

Keet

Louw

2018

Southern African Journal of Anaesthesia and Analgesia

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Knowledge of the anatomy of the infraclavicular fossa is important as this region is a target site for anaesthesia of the upper limb during infraclavicular approaches to brachial plexus blocks and in central venous cannulation of the axillary or subclavian veins. The cords of the brachial plexus and the axillary artery and vein are classically described as being located deep to the pectoralis minor and major muscles in the infraclavicular fossa. A rare variation was observed on one side of an individual, out of a total of 170 dissections, in which the brachial plexus and axillary artery were located between the pectoralis minor and major muscles. This variation was observed on the right-hand side of a male cadaver, and resulted in a more superficial position of the cords of the brachial plexus and axillary artery in relation to the skin. This superficial position of these vital structures may lead to an increased risk of complications during clinical procedures, such as infraclavicular brachial plexus blocks, central venous cannulation or surgery. Ultrasound should be used whenever possible to visualise variant positions of arteries, veins, nerves or muscles during these and other procedures.

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“…Knowledge of the anatomic pattern and potential variations in the development of the brachial plexus is important in specific situations. For example, it can guide local and regional anaesthetic blocking techniques that result in the analgesia of somatic structures in thoracic limbs (Futema et al 1999;Mencalha et al 2016;Mistry et al 2016;Shinn et al 2016).…”

Section: Introductionmentioning

confidence: 99%

Origin and antimeric distribution of brachial plexus nerves inAlouatta guariba clamitansCabrera, 1940 (Primates: Atelidae)

Souza

Carvalho

Döwich

et al. 2018

The European Zoological Journal

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The Southern brown howler monkey, Alouatta guariba clamitans, is one of the largest Neotropical primates. The objective of this study was to describe the origin and antimeric distribution of brachial plexus nerves in A. g. clamitans and, thereby, to provide information for comparative anatomy and for anatomy applied to loco-regional anaesthetic blocking in primates. For this purpose, a macrodissection of 10 thoracic limbs of corpses that were collected from highways was performed, and the corpses were stored in 10% formaldehyde solution. The brachial plexus was essentially formed from the ventral spinal branches of segments C5 to T1, although in one specimen the contribution of C4 and in another specimen the contribution of T2 was registered. There was a grouping of ventral branches in cranial, medium and caudal trunks, and branches of C5 and C7 were the ones that mostly contributed to the origin of nerves from the plexus. Comparatively, the brachial plexus from A. g. clamitans reflected characteristics that are typical in the primate order, but also of mammal species that require versatility and precision in movements of the thoracic limbs. On the basis of that similarity, it is proposed that anatomic landmarks for anaesthetic block techniques used in other primate species may be successfully applied to A. g. clamitans.

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Assessment of variation in depth of brachial plexus using ultrasound for supraclavicular brachial plexus block in patients undergoing elective upper limb surgery

Cited by 6 publications

References 10 publications

Origin and antimeric distribution of brachial plexus nerves in Macaca mulatta (Zimmermann, 1780) (Primates: Cercopithecidae)

Origin and antimeric distribution of brachial plexus nerves in Macaca mulatta (Zimmermann, 1780) (Primates: Cercopithecidae)

Superficial location of the brachial plexus and axillary artery in relation to pectoralis minor: a case report

Origin and antimeric distribution of brachial plexus nerves inAlouatta guariba clamitansCabrera, 1940 (Primates: Atelidae)

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