Factors Influencing Distribution of Local Anesthetic Injected into the Brachial Plexus Sheath

Winnie, Alon P.; Radonjic, Radisa; Akkineni, Sudarsana Rao; Durrani, Zia

doi:10.1097/00132586-198004000-00056

Cited by 42 publications

(18 citation statements)

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“…The assessment of embedded area after subscapular injection was proposed due to a scarceness data in the veterinary literature regarding the correlation between the volume of local anesthetic administered and efficacy of brachial plexus block 7 . When it comes to feline medicine such data are even less enlightening 8 , causing doubts and fears on the part of anesthesiologists.…”

Section: Discussionmentioning

confidence: 99%

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A cadaveric study to determine the minimum volume of methylene blue to completely color the nerves of brachial plexus in cats. An update in forelimb and shoulder surgeries

Mencalha¹,

Fernandes²,

Sousa

et al. 2014

Acta Cir. Bras.

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PURPOSE:To determine the minimum volume of methylene blue (MB) to completely color the brachial plexus (BP) nerves, simulating an effective anesthetic block in cats. METHODS:Fifteen adult male cat cadavers were injected through subscapular approach with volumes of 2, 3, 4, 5 and 6 ml in both forelimbs, for a total of 30 brachial plexus blocks (BPB). After infusions, the specimens were carefully dissected preserving each nervous branch. The measurement of the effective area was indicated by the impregnation of MB. Nerves were divided into four segments from the origin at the spinal level until the insertion into the thoracic limb muscles. The blocks were considered effective only when all the nerves were strongly or totally colored. RESULTS:Volumes of 2, 3 and 4 ml were considered insufficient suggesting a failed block, however, volumes of 5 and 6 ml were associated with a successful block. CONCLUSIONS:The injection of methylene blue, in a volume of 6 ml, completely colored the brachial plexus. At volumes of 5 and 6 ml the brachial plexus blocks were considered a successful regional block, however, volumes of 2, 3 and 4 ml were considered a failed regional block.

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Section: Discussionmentioning

confidence: 99%

“…The volume of solution injected is a relevant factor for successful anesthesia [7][8][9][10] . In the majority of the medical literature, the dose of local anesthetic chosen for brachial plexus block is mainly associated with the drug concentration and volume.…”

Section: Discussionmentioning

confidence: 99%

A cadaveric study to determine the minimum volume of methylene blue to completely color the nerves of brachial plexus in cats. An update in forelimb and shoulder surgeries

Mencalha¹,

Fernandes²,

Sousa

et al. 2014

Acta Cir. Bras.

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show abstract

“…This prospective, randomized, double blind study was done in patients undergoing upper limb surgery with a similar surgical and demographical profile. A volume of 40 ml of local anaesthetic agent was taken as this volume was associated with a more complete spread for brachial plexus block as found by Winnie and colleagues 9 .…”

Section: Discussionmentioning

confidence: 99%

Buprenorphine as an adjuvant in supraclavicular brachial plexus block.

Singam

Chaudhari

Nagrale

2012

Int J of Biomed & Adv Res

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Background & Aims: Brachial plexus block is a useful alternative to general anaesthesia. Postoperative analgesia is an added advantage. Buprenorphine, an agonist antagonist opioid has been used by various routes to prolong analgesia. The present study was undertaken to assess the analgesic efficacy of Buprenorphine with Bupivacaine in brachial plexus block. Methods: A prospective, randomized, double blind study was done on 60 adult patients of American Society of Anesthesiologists 1 and 2, aged between 18-50 years and scheduled for various upper limb surgeries. Patients were divided into two groups of 30 each. Group C (control group) received 38ml of inj. bupivacaine 0.25% +2ml normal saline and group B (Buprenorphine group) received 38ml of inj. bupivacaine 0.25% +2ml inj. Buprenorphine (preservative free) (0.3 mg). Patients were observed for onset and duration of motor block, onset and duration of sensory block, duration of pain relief and occurrence of any complications. Results: Post operative analgesia was significantly longer (901.33±60.04 min) in group B, as compared to group C (343.00±33.02 min) with p value <0.001. Duration of sensory block in group C was 322.16±31.80 min and in group B 647.83±55.70 min. with p value <0.001. Pain score was significantly low in group B (mean 1.44), compared to group C (mean 5.60) at 12 hours postoperatively. Conclusion: Addition of Buprenorphine 0.3 mg to 38ml of bupivacaine 0.25% for supraclavicular brachial plexus block prolonged sensory blockade and post-operative analgesia without increasing the risk of adverse effects.

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“…Anatomical literature suggests that a connective tissue sheath surrounds the brachial plexus as a thin membrane [9][10][11][12]. Franco et al in a recent cadaver study of the brachial plexus sheath described the membrane as only 1-to 2-mm thick and observed that the sheath could be easily detached from the surrounding muscle bed [10].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided interscalene blocks: understanding where to inject the local anaesthetic

Spence

Beach²,

Gallagher

et al. 2011

Anaesthesia

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SummaryAlthough ultrasound-guided regional anaesthesia has gained in popularity, few data exist describing the optimal location(s) to inject local anaesthetic. Our objective was to compare, for interscalene blocks, the effectiveness of an injection between the middle scalene muscle and brachial plexus sheath (peri-plexus) with an injection within the brachial plexus sheath (intra-plexus). We enrolled 170 patients undergoing shoulder surgery with general anaesthesia and interscalene block in this randomised, controlled trial. Our primary outcome variable was loss of shoulder abduction. Block quality was also measured and defined by an evaluation of onset time, sensory and motor loss and duration. There was no difference between the two groups in block onset times or block quality. After adjusting for sex, age and volume injected, intra-plexus blocks lasted a mean of 2.6 h (16%) longer (95% CI 0.25-5.01, p = 0.03) than peri-plexus blocks.

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Factors Influencing Distribution of Local Anesthetic Injected into the Brachial Plexus Sheath

Cited by 42 publications

References 0 publications

A cadaveric study to determine the minimum volume of methylene blue to completely color the nerves of brachial plexus in cats. An update in forelimb and shoulder surgeries

A cadaveric study to determine the minimum volume of methylene blue to completely color the nerves of brachial plexus in cats. An update in forelimb and shoulder surgeries

Buprenorphine as an adjuvant in supraclavicular brachial plexus block.

Ultrasound‐guided interscalene blocks: understanding where to inject the local anaesthetic

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