Le nerf radial doit être anesthésié avant le nerf cubital pendant un blocage du plexus brachial au travers du canal huméral

Guntz, Emmanuel; Herman, Pierre; Delbos, Alain; Sosnowski, Maurice

doi:10.1007/bf03018239

Cited by 10 publications

(2 citation statements)

References 13 publications

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“…In a previous study, we suggested blocking the deepest nerves before the superficial ones in order to improve the safety of the technique. 10 Our results confirm the efficacy of this sequence for rather different reasons.…”

Section: Discussionsupporting

confidence: 72%

Ultrasound-guided block of the brachial plexus at the humeral canal

Guntz

Broeck

Dereeper

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Conduction block of the brachial plexus block at the humeral canal, as described by Dupre, has certain clinical indications. The aim of this preliminary study was to assess the feasibility of this technique under ultrasound guidance. Methods After ultrasound evaluation of the brachial plexus at the humeral canal in 61 adult volunteers, we performed ultrasound-guided blocks in another 20 adult patients. A linear 38 mm probe, 13-6 MHz, and a 50-mm insulated block needle were used to guide injection of lidocaine 1.5% with epinephrine. Results Ulnar and median nerves are superficial and located at similar depths. Ultrasound imaging showed the musculocutaneous nerve to be located dorsally. The radial nerve is dorsal to the plane of the musculocutaneous nerve. Relative to the brachial artery, the median nerve is situated between 12 and 1 o'clock in 66% of the cases. Relative to the basilic vein, the ulnar nerve is situated at 3 o'clock in 46% of the cases. The evaluated block sequence was radial, ulnar, musculocutaneous and median nerve; two points of puncture were mandatory, and 6.85 ± 0.37 min were required to perform the blocks. Sensory onset times were similar for the four nerves. Injectate volume was lower for the musculocutaneous nerve compared to other nerves (P \ 0.05). All 20 patients experienced complete sensory and motor blocks. ConclusionWe describe an approach to, and the feasibility of ultrasound-guided block of the brachial plexus at the humeral canal. Further study will be required to establish the effectiveness and the safety of this technique. RésuméObjectif Les blocs de conduction du plexus brachial au niveau du canal hume´ral tels que de´crits par Dupre ont certaines indications cliniques. L'objectif de cette e´tude pre´liminaire e´tait d'e´valuer la faisabilite´de cette technique par e´choguidage. Méthode Apre`s une e´valuation ultrasonographique du plexus brachial au niveau du canal hume´ral chez 61 volontaires adultes sains, nous avons re´alise´des blocs par e´choguidage chez 20 autres patients adultes. Une sonde line´aire de 38 mm, 13-6 MHz, et une aiguille de bloc isole´e de 50 mm ont e´te´utilise´es pour guider l'injection de lidocaı¨ne 1,5% avec e´pine´phrine. Résultats Les nerfs cubital et me´dian sont superficiels et situe´s à des profondeurs similaires. L'imagerie par ultrason a montre´que le nerf musculocutane´e´tait situe´en position dorsale. Le nerf radial est dorsal au plan du nerf musculocutane´. Par rapport a`l'arte`re brachiale, le nerf me´dian se situe entre midi et une heure dans 66% des cas. Par rapport a`la veine basilique, le nerf cubital se situe a`3 heures dans 46% des cas. La se´quence de bloc e´value´e se situait au niveau des nerfs radial, cubital, musculocutaneé t me´dian; deux points de ponction e´taient requis, et 6,85 ± 0,37 min ont e´te´ne´cessaires pour re´aliser les blocs. Les de´lais d'action sensitifs e´taient semblables pour les 4 nerfs. Le volume de la dose injecte´e e´tait plus bas pour le nerf musculocutane´comparativement aux autres nerfs (P ...

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Section: Discussionsupporting

confidence: 72%

Ultrasound-guided block of the brachial plexus at the humeral canal

Guntz

Broeck

Dereeper

et al. 2009

Can J Anesth/J Can Anesth

Self Cite

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“…105 When using a 4-nerve-stimulation, midhumeral approach, blocking the radial nerve before the ulnar nerve improves subsequent nerve localization. 106 Third, the relationship of the musculocutaneous nerve to the brachial plexus deserves special consideration, because it courses away from the axillary artery early and resides within the body of the coracobrachialis muscle or the fascial layers between the coracobrachialis and the biceps muscles. Anesthesia of the musculocutaneous nerve is best ensured by a separate injection into the belly of the coracobrachialis muscle 99,107 or by using direct ultrasound guidance.…”

Section: Axillary Blockmentioning

confidence: 99%

Upper Extremity Regional Anesthesia

Neal¹,

Gerancher

Hebl

et al. 2009

Regional Anesthesia and Pain Medicine

303

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Brachial plexus blockade is the cornerstone of the peripheral nerve regional anesthesia practice of most anesthesiologists. As part of the American Society of Regional Anesthesia and Pain Medicine's commitment to providing intensive evidence-based education related to regional anesthesia and analgesia, this article is a complete update of our 2002 comprehensive review of upper extremity anesthesia. The text of the review focuses on (1) pertinent anatomy, (2) approaches to the brachial plexus and techniques that optimize block quality, (4) local anesthetic and adjuvant pharmacology, (5) complications, (6) perioperative issues, and (6) challenges for future research.Upper extremity regional anesthesia has been a mainstay of the anesthesiologist's armamentarium since Hall 1 first reported the use of cocaine to block the brachial plexus in 1884. Recognizing that upper extremity neural blockade represents the most frequent use of peripheral nerve blocks in most anesthesiologists' practice, 2 in 2001, the American Society of Regional Anesthesia and Pain Medicine (ASRA) undertook a critical review of all available English-language publications pertinent to this topic. The resulting extensive source document was synthesized into a comprehensive review article 3 that was published in 2002; both the source and the review documents will be updated approximately every 5 years.Rather than publishing only new material that has become available since 2002, the original review article has been completely revised so that readers may continue to view the subject matter in its entirety. New topics in this review include ultrasound-guided brachial plexus block, continuous catheter-based analgesia, and a collection of new images * by medical illustrator, Jennifer Gentry (www.gentryvisualization.com). This review summarizes the essential scholarly work available from the source document, which can be viewed at Copyright © 2009 by American Society of Regional Anesthesia and Pain Medicine Address correspondence to: Joseph M. Neal, MD, 1100 Ninth Ave (B2-AN), Seattle, WA 98101 (anejmn@vmmc.org). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of this entity. James P. Rathmell, MD, served as acting editor-in-chief for this article.Financial support: None. NIH Public Access Author ManuscriptReg Anesth Pain Med. Author manuscript; available in PMC 2010 March 1. Published in final edited form as:Reg Anesth Pain Med. 2009 ; 34(2): 134-170. doi:10.1097/AAP.0b013e31819624eb. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript www.asra.com. This review article strives (1) to serve as a review of pertinent anatomy, (2) to compare the effectiveness of brachial plexus approaches and techniques, (3) to present available evidence to guide selection of pharmacological agents, (4) to describe the complications inherent to upper extremity anesthesia, (5) to consider pertinent perioperative issues, and (6) to identify informational gaps and empha...

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