Brachial plexus: demonstration at US.

Sheppard, Declan C.; Iyer, Revathy B.; Fenstermacher, Marc J.

doi:10.1148/radiology.208.2.9680567

Cited by 91 publications

(65 citation statements)

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“…The recent successful attempts to use US for imaging of the brachial plexus anatomy in particular [5,6] and peripheral nerve in general [7] encouraged this prospective US study of brachial plexopathies. The aim of the current study was to explore the potential of this technique in recognizing lesions in the region of the brachial plexus, characterizing their nature and assessing their extension and relation to adjacent anatomic structures.…”

Section: Introductionmentioning

confidence: 99%

Sonographic evaluation of brachial plexus pathology

et al. 2004

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Pre-operative US examinations of the brachial plexus were performed with the purpose of exploring the potential of this technique in recognizing lesions in the region and defining their sonographic morphology, site, extent, and relations to adjacent anatomic structures, and comparing them to the surgical findings to obtain maximal confirmation. Twenty-eight patients with clinical, electro-conductive, and imaging findings suggestive of brachial plexus pathology were included in this study. There were four main etiology groups: post-traumatic brachial plexopathies; primary tumors (benign and malignant); secondary tumors; and post irradiation injuries. Twenty-one of the 28 patients underwent surgery. Advanced imaging (mostly MRI) served as an alternative gold standard for confirmation of the findings in the non-surgically treated group of patients. The US examinations were performed with conventional US units operating at 5- to 10-MHz frequencies. The nerves were initially localized at the level of the vertebral foramina and then were followed longitudinally and axially down to the axillary region. Abnormal US findings were detected in 20 of 28 patients. Disruption of nerve continuity and focal scar tissue masses were the principal findings in the post-traumatic cases. Focal masses within a nerve or adjacent to it and diffuse thickening of the nerve were the findings in primary and secondary tumors. Post-irradiation changes presented as nerve thickening. Color Doppler was useful in detecting internal vascularization within masses and relation of a mass to adjacent vessels. The eight sonographically negative cases consisted either of traumatic neuromas smaller than 12 mm in size and located in relatively small branches of posterior location or due to fibrotic changes of diffuse nature. Sonography succeeded in depicting a spectrum of lesions of traumatic, neoplastic, and inflammatory nature in the brachial plexus. It provided useful information regarding the lesion site, extent, and anatomic relationships; thus, the principal aims of the study were therefore met. Once the technique of examination is mastered, sonography should be recommended as part of the pre-operative evaluation process post-ganglionic brachial plexus pathology. Most disadvantages are related to the restricted field of view and inability to overcome bonny obstacles particularly in evaluating pre-ganglionic region. As sonography is frequently employed for investigation of the supraclavicular region, awareness of the radiologist to the findings described may enable the early recognition of pathologies involving or threatening to involve the brachial plexus.

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Section: Introductionmentioning

confidence: 99%

Sonographic evaluation of brachial plexus pathology

et al. 2004

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“…The use of U/S in ISBPB provides good and clear visualization of all anatomical structures, and may reveal anatomical variations. In most cases, the nerve trunks can be easily identified, placement of the needle to an optimum position next to the nerve trunks can be accomplished in a single needle pass and that help to decrease the suspected complications during injection [6,7].…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound guidance has been found to be helpful during the performance of brachial plexus anesthesia, particularly since advanced equipment with compound imaging and high-resolution probes have become available [5]. Since, in most cases, the nerve trunks can be easily identified, placement of the needle to an optimum position next to the nerve trunks can be accomplished in a single needle pass and that help to decrease the suspected complications during injection [6,7]. Although the above mentioned advantages of the ultrasound-guided ISBPB over the anatomical landmark procedure, there is still debate about the efficacy and usefullnes of the use of such a procedure and further researches are needed to ascertain the impact of ultrasound guidance on block success rates and safety [8].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Interscalene Nerve Block: An Alternative Technique to Anatomical Landmark-Guided Approaches

2016

JACCOA

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Background: The use of ultrasonography in interscalene brachial plexus block (ISBPB) has rapidly evolved over the past few years. It has been speculated that ultrasound guidance might increase success rates and reduce complications.Objective: The aim of our study is to compare the success rate and safety of ISBPB performed either with ultrasound visualization or with anatomical landmark to guide needle placement. Methods:A total of 44 patients scheduled for shoulder and upper arm surgeries in Zagazig University hospital, Zagazig, Egypt, were included in this prospective study and randomized into two equal groups according to the guidance method for ISBPB. In the ultrasound group (group A), the brachial plexus was visualized with a linear 38-mm, high frequency 7 MHz probe and the spread of the local anesthetic was assessed. In anatomical landmark group (group B), the roots of the brachial plexus were located by eliciting parasthesias when the target nerves were touched by the needle.Results: Surgical anesthesia was achieved in 91% of patients in group A vs. 73 % of patients in group B (p= 0.01). The dose of anesthesia was significantly lower in group A compared to group B. Also, duration of anesthesia was increased and the need for analgesia was reduced in group A. The incidence of complications was significantly higher in group B (45%) than in group A (18%) (p= 0.01). Conclusion:The use of ultrasonography helps to improve the efficacy and to reduce the complications associated with ISBPB.

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“…But it was the use of B-mode ultrasound (Ting and Sivagnanaratnam, 1989) for axillary block performance that heralded the era of ultrasound-guided peripheral nerve block [36]. Sheppard et al (1998) evaluated the ability of ultrasound to visualize components of the brachial plexus, using MRI as a guide to background anatomy. They described the plexus as having a hypoechoic appearance within hyperecoic rims which were tubular on longitudinal scans and oval to round on transverse scan they also felt that color doppler was essential to prevent the confusion of nerves with small blood vessels [33].…”

Section: Introductionmentioning

confidence: 99%

“…Sheppard et al (1998) evaluated the ability of ultrasound to visualize components of the brachial plexus, using MRI as a guide to background anatomy. They described the plexus as having a hypoechoic appearance within hyperecoic rims which were tubular on longitudinal scans and oval to round on transverse scan they also felt that color doppler was essential to prevent the confusion of nerves with small blood vessels [33]. Yang et al (1998) studied anatomy of the brachial plexus under ultrasound and subsequently used it to guide the placement of catheters for interscalene and supraclavicular blocks for an arm surgery in humans [38].Guilherme and Benigni (2008) described a technique for ultrasound of the brachial plexus and major nerves of canine thoracic limb by positioning the probe in a parasaggital plane between the sternum and the shoulder with the ultrasound beam directed caudally, a transverse image of the brachial plexus close to the origin of the axillary atery and vein was obtained [18].…”

Section: Introductionmentioning

confidence: 99%

Comparative Evaluation of Conventional Anatomical Landmark Guided, Perineural Ultrasound Guided and Perivascular Colour Doppler Guided Brachial Plexus Block In Sheep

Mirza¹

2017

IJRASET

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Thirty six adult sheep irrespective of sex, randomly allotted to six groups i.e., A, B, C, D, E & F with six animals each formed the subjects of study with the objectives to identify the window most feasible and an alternative site to conventional site for localization of brachial plexus in adult sheep and its subsequent blockade under ultra sonographic guidance; to compare the perineural brachial plexus blockade (BPB) using ultrasound guidance and perivascular BPB using color doppler and to ascertain possible dose regimen variation and anesthetic effect with and without ultrasound guidance. All the animals received 0.75% ropivacaine hydrochloride @ 3mg/kgBW. Perineural ultrasound guided BPB was performed in animals of group A & B, in which group A animals received ropivacaine whereas group B animals received additional 4mg isoflupredone, perivascular colour doppler guided BPB was performed in groups E & F, in which received ropivacaine and ropivacaine plus 4mg isoflupredone respectively. BPB in groups C & D was performed using landmark approach using ropivacainein group C and additional 4mg isoflupredone in group D. We identified the ultrasound scanning window. The perivascular and perineural BPB allowed a feasible and accurate access to BP and significantly shortened the onset and prolonged the duration of anesthesia as compared to conventional technique of BPB. By incorporating 4mg isoflupredone, ropivacaine dose was reduced by 15mg. Therefore, it could be concluded that this anesthetic regimen can provide a very good anesthesia for forelimb surgery upto four hours duration in sheep.

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Brachial plexus: demonstration at US.

Cited by 91 publications

References 0 publications

Sonographic evaluation of brachial plexus pathology

Sonographic evaluation of brachial plexus pathology

Ultrasound-Guided Interscalene Nerve Block: An Alternative Technique to Anatomical Landmark-Guided Approaches

Comparative Evaluation of Conventional Anatomical Landmark Guided, Perineural Ultrasound Guided and Perivascular Colour Doppler Guided Brachial Plexus Block In Sheep

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