Bases anatômicas para o bloqueio anestésico do plexo braquial por via infraclavicular

Abstract

RESUMO

Infraclavicular Topography of the Brachial Plexus Fascicles in Different Upper Limb Positions

“…However, studies involving a larger and more diverse sample of cadavers and considering sex, race, age, biotype and cadaveric rigidity are needed to standardize the variations that can occur in the formation and topographic arrangement of the brachial plexus. These data would have a direct impact on the conservative and surgical approach to the treatment of upper limb neuropathies (Gusmão et al;Butler;Flores, 2006;Flores, 2011 ).…”

“…Knowledge of the infraclavicular topography of the brachial plexus is important for the evaluation of these injuries, as well as parameters during upper limb surgical procedures that require brachial plexus block (Gusmão et al, 2002). According to Imbelloni et al (2001), infraclavicular block of the brachial plexus provides adequate anesthesia in cases of upper limb surgery and knowledge of the local anatomy is essential to prevent errors such as vascular punctures or complications due to pneumothorax.…”

Evaluation of brachial plexus fascicles involvement on infraclavicular block: unfixed cadaver study

“…11 In several recommended access routes the anesthetic injection site was not always within the infraclavicular fossa and there is no information about the fossa site through which the brachial plexus and axillary vessels pass. The access route proposed by Gusmão et al 11 shows that, in most cases, the brachial plexus fasciculi are located in this fossa and, for security in the implementation of the blockade by the anesthesiologist, it was given the information not only of the depth where the plexus is located, but also its location within the infraclavicular fossa, from the angle formed by the deltoid muscle and the clavicle.…”

“…The infraclavicular route was used, through the infraclavicular fossa, as stated by Gusmão et al 11 Instead of the anesthetic, we used a dilute solution of neoprene latex with dye (30 Ml). After injection, the bodies were placed into the refrigerator, where they remained for about three weeks.…”

“…11 In 2002, Gusmão et al 11 used one hundred fixed cadavers and performed infraclavicular fossa dissection, which was present in 96% of cases, determining that brachial plexus block by this route should be performed after finding the angle formed by the junction of the anterior margin of the deltoid muscle and the clavicle, draw a bisector from the angle to the fossa center, measuring about 2.21 cm, and enter the needle perpendicular to the skin at this site with a depth of 3.0---3.5 cm, piercing the axillary sheath and reaching the brachial plexus, which are located at this level, laterally to the axillary vessels.…”