Influence of arm position on ultrasound visibility of the axillary brachial plexus

Frković, Vedran; Ward, Catherine; Preckel, Benedikt; Lirk, Phillip; Hollmann, Markus W.; Stevens, Markus F.; Wegener, Jessica

doi:10.1097/eja.0000000000000293

Cited by 8 publications

(4 citation statements)

References 17 publications

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“…All the assessors were blinded to the approach. The visibility scores were determined using a 6-point visibility scale: 0, no nerve identified; 1, nerve identified with high probability; 2, nerve identified but most of it not visible; 3, nerve identified and > 50% of its borders precisely distinguished from surrounding structures; 4, nerve completely visible but fascicles poorly defined; and 5, nerve completely visible and multiple fascicles identifiable (9). During the SNB procedure, a nurse anesthetist recorded the scan time (from transducer placement to SN identification), SN depth (distance from the skin to the superficial SN surface), time taken to elicit foot plantarflexion or dorsiflexion, time taken to perform the SN block (from needle insertion to withdrawal), needle depth (distance from the skin to the needle tip), number of needle passes (deliberate needle tip withdrawal to skin level or additional skin puncture), the visual analogue scale (VAS), and occurrence of SNB complications such as inadvertent vessel puncture and local anesthetic systemic toxicity.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of ultrasound-guided above-knee lateral approach for popliteal sciatic nerve block in surgeries below the knee: a randomized controlled trial

Zhu¹,

Chanjuan²,

Zhang³

et al. 2021

Ann Palliat Med

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Background: Ultrasound guidance has become a standard method for detection of nerve structures in regional anesthesia. During ultrasound-guided blockade, to identify anatomical structures is crucial but can be challenging. In clinical practice, we find a wide difference in the visibility score of the sciatic nerve (SN) through different approaches. This study aimed to compare SNB through the anterior and above-knee lateral approach in terms of identification ease, performance efficacy, and safety.Methods: Patients scheduled for below-knee surgery were randomized to either receive SNB using the above-knee lateral approach (Group L, n=27) or the anterior approach (Group A, n=26). The primary outcome was the visibility score of SN. Secondary outcomes included the time taken to identify the SN, nerve depth, success rate of SN identification, number of needle passes, time to elicit foot flexion, needle depth, and occurrence of SNB complications. Additionally, the sensory block onset and analgesia duration were assessed.Results: We included 53 adult patients. Compared with Group A, Group L showed a higher SN visibility score [3.25 (3.17, 3.67) vs. 2.50 (1.86, 2.68), P<0.001]. The scan time was significantly shorter in Group L 8.70 (6.01) s vs. 31.54 (11.87) s, P<0.001). The depth of the SN was 3.20 (0.56) cm in Group L and 5.53 (0.84) cm in Group A (P<0.001), and the needle insertion depth was 7.15 (0.90) cm in group L and 8.32 (1.13) cm in Group A (P<0.001). The number of needle passes was less in Group L, as well as the time to elicit foot flexion, and the time taken to perform the SN block (all P<0.001). The success rate of SN identification was non-significantly higher in Group L. There was no significant between-group difference in the onset of sensory block, as well as postoperative analgesia duration. None of the approaches involved acute systemic toxicity and hematoma occurrence.Conclusions: Based on the visibility score, the above-knee lateral approach allowed easy SN identification and safe SNB. Using the ultrasound-guided above-knee lateral approach for SNB in below-knee surgeries could be a reliable choice.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of ultrasound-guided above-knee lateral approach for popliteal sciatic nerve block in surgeries below the knee: a randomized controlled trial

Zhu¹,

Chanjuan²,

Zhang³

et al. 2021

Ann Palliat Med

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“…For instance, the brachial plexus in the axillary region should be approached with the extremity positioned as described in relevant publications (3).…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, the position of the nerves inside the sheath is not fixed and does not allow a certain extent of movement. Moreover, fibres, to a variable degree, are exchanged between individual nerves (3). Variability of the axillary fossa anatomy may challenge blockage of the main brachial nerves one by one.…”

Section: Introductionmentioning

confidence: 99%

Importance of the Upper Extremity Position for a Safe and Effective Axillary Block: a Comparative Study

Öztürk¹,

Tezcan²,

Bilge³

et al. 2017

Turk J Anaesth Reanim

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Objective: Our aim was to determine the ideal position of upper extremities during ultrasonography guidance for axillary block. The position that provides the shortest distance between the median and musculocutaneous nerves was assumed to be the most appropriate position for axillary block. Methods:In this cross-sectional study, 120 (45 female and 75 male) patients were placed in a position with a shoulder at 90° / elbow 90° (position 1) and a shoulder 90° / elbow 0° (position 2). The intersection point of the biceps brachii muscle with the lower border of the pectoralis major muscle is defined as the proximal level (P). Distal level (D) is reffered as 5 cm below the proximal level. In the positions described above, the distance between median and musculocutaneous nerves was measured proximal (positions 1P and 2P) and distal levels (positions 1D and 2D). It was investigated whether these measurements differed between the groups and whether the body mass index or the gender. Results:The shortest mean distance (10.24±3.95 mm) between the two nerves was determined when the shoulder position 90°/ elbow position 0° at the distal level (1D) and the longest mean distance (13.41±4.26 mm) was determined when shoulder position 90°/elbow position 90° at the proximal level (2P). In all four cases, there was no difference in the results between men and women. There was no relationship between the measurement results and the body mass indexes and age of the patients. Conclusion:Appropriate positioning of the upper extremities is important for achieving optimal position during axillary block. Thereby, the procedure can be safely and effectively performed with lesser amounts of local anaesthetic solution and a decreased number of manoeuvres with needle during infiltration.Keywords: Axillary block, ultrasound guidance, median nerve, musculocutaneous nerve Amaç: Amacımız, ultrason kılavuzluğunda yapılan aksiller blok sı-rasında üst ekstremitenin ideal pozisyonunu belirlemektir. Median ve muskulokutanöz sinirler arasında en kısa mesafeyi sağlayan pozisyonun aksiller blok için en uygun pozisyon olduğu varsayılmıştır.Yöntemler: Bu kesitsel çalışmada 120 (45 kadın ve 75 erkek) hastada her bir kola omuz 90°/dirsek 90°'de (pozisyon 1) ve omuz 90°/dirsek 0°'de (pozisyon 2) olacak şekilde pozisyon verildi. Pektoralis major kasının alt sınırıyla biseps brachii kasının kesişme noktası proksimal seviye (P) olarak tanımlanmıştır. P'nin 5 cm distaline distal seviye (D) denilmiştir. Yukarıda anlatılan pozisyonlarda median ve muskulokutanöz sinirler arasındaki mesafe proksimal (pozisyon 1P ve 2P) ve distal seviyelerde (pozisyon 1D ve 2D) ölçüldü. Tüm bu ölçümlerin gruplar arasında farklılığı ve hastaların beden kitle indeksi yada cinsiyetiyle değişiklik gösterip göstermediği araştırıldı. Bulgular:İki sinir arasındaki en kısa ortalama mesafe (10,24±3,95 mm) distal seviyede omuz 90°/dirsek 0° pozisyonda (1D), en uzun ortalama mesafe (13,41±4,26 mm) ise proksimal seviyede omuz 90°/dirsek 90° pozisyonda (2P) iken saptanmıştır. Dört durumda da sonuç...

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“…Μπορεί να απαιτηθεί μικρότερος όγκος, αλλά λιγότερος όγκος ΤΑ για κάθε νεύρο οδηγεί σε αποκλεισμό μικρότερης διάρκειας. Μασχαλιαίος αποκλεισμός με υπέρηχο Η απεικόνιση γίνεται με απαγωγή του άνω άκρου σε γωνία 90 μοιρών, καθώς η θέση του άκρου μπορεί να επηρεάσει τη θέση των νεύρων σε σχέση με την αρτηρία 87 Εικόνα 6. Πολυμορφισμός της ανατομίας του βραχιονίου πλέγματος στην περιοχή της μασχάλης.…”

Section: εικόνα 1 ανατομία του βραχιονίου πλέγματος στην περιοχή της μασχάλης (πάνω) και στο μέσον του βραχίονα (κάτω) Snarouze Atlas Of unclassified

Συγκριτική Μελέτη Περιφερικών Νευρικών Αποκλεισμών Με Χρήση Δύο Διαφορετικών Τεχνικών

Σταυράτη¹

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Σκοπός: Η μασχαλιαία προσέγγιση έχει ευρεία απήχηση ως προς τον αποκλεισμό του βραχιονίου πλέγματος, είτε με χρήση υπερήχων, είτε με νευροδιέγερση. Ο σκοπός της μελέτης μας ήταν να συγκρίνουμε τις δύο μεθόδους ανίχνευσης, όσον αφορά τον χρόνο έναρξης, την ποιότητα, τη διάρκεια του αποκλεισμού, την μετεγχειρητική αναλγησία και τις επιπλοκές. Υλικό-Μέθοδος: Η μελέτη μας ήταν προοπτική, τυχαιοποιημένη, μονή τυφλή. Έλαβε χώρα στο τριτοβάθμιο πανεπιστημιακό νοσοκομείο Αλεξανδρούπολης σε ασθενείς, που χρειάσθηκαν εγχείρηση άνω άκρου. Συνολικά τυχαιοποιήθηκαν 122 ασθενείς κατάταξης ASA I-III, προγραμματισμένοι για μασχαλιαίο αποκλεισμό, είτε με υπέρηχο ή με νευροδιεγέρτη. Απ' αυτούς τελικά, ογδόντα εννέα ασθενείς συμπλήρωσαν τα κριτήρια και αναλύθηκαν για την έρευνα. Η στατιστική ανάλυση των στοιχείων των ασθενών, έγινε με την χρήση του προγράμματος SPSS 16.0 (SPSS Inc, IBM Chicago, IL, ΗΠΑ).Αποτελέσματα: Τα κύρια αποτελέσματα που αξιολογήθηκαν ήταν ο χρόνος μέχρι την έναρξη αναισθησίας, ο οποίος ήταν κατά μέσο όρο έξι λεπτά λιγότερος στην ομάδα της υπερηχογραφικής ανίχνευσης, ο αριθμός τσιμπημάτων με βελόνη για τον αποκλεισμό που ήταν περισσότερα για την ομάδα του νευροδιεγέρτη και ο πλήρης αισθητικός και κινητικός αποκλεισμός που εμφανίστηκε συχνότερα στην ομάδα των υπερήχων. Όλα τα παραπάνω ήταν στατιστικά σημαντικά (p<0.05). Το ποσοστό επιτυχίας (p=0.06) και η πιθανότητα αναρρόφησης αίματος (p=0.49) συγκρίθηκαν ανάμεσα στις ομάδες χωρίς να σημειωθεί όμως στατιστικά σημαντική διαφορά. Συμπεράσματα: Η χρήση υπερήχων για τον αποκλεισμό του βραχιονίου πλέγματος με μασχαλιαία προσπέλαση σε σύγκριση με τη χρήση νευροδιεγέρτη οδηγεί σε γρηγορότερη έναρξη αναισθησίας, μικρότερο αριθμό τρυπημάτων με βελόνη και καλύτερο αισθητικό και κινητικό αποκλεισμό. Ωστόσο, η τρώση αγγείου στην εκτός πεδίου προσπέλαση είναι το ίδιο πιθανή με τις δύο μεθόδους.

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Influence of arm position on ultrasound visibility of the axillary brachial plexus

Abstract: https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm Identifier: NL42116.018.12.

Cited by 8 publications

References 17 publications

Efficacy and safety of ultrasound-guided above-knee lateral approach for popliteal sciatic nerve block in surgeries below the knee: a randomized controlled trial

Efficacy and safety of ultrasound-guided above-knee lateral approach for popliteal sciatic nerve block in surgeries below the knee: a randomized controlled trial

Importance of the Upper Extremity Position for a Safe and Effective Axillary Block: a Comparative Study

Συγκριτική Μελέτη Περιφερικών Νευρικών Αποκλεισμών Με Χρήση Δύο Διαφορετικών Τεχνικών

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