Truncal injection brachial plexus block: A Description of a novel injection technique and dose finding study

Sivashanmugam, T; Sripriya, R; Jayaraman, Gobinath; Ravindran, C; Ravishankar, M

doi:10.4103/ija.ija_803_19

Cited by 11 publications

(6 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We are unable to directly compare our results with the published data, because different methodologies, drugs and criteria to define the onset of BPB, were used in previous research studies. Nevertheless, published data indicates that blockade of the median and ulnar nerves is in general slower in onset than the axillary and musculocutaneous nerves after a BPB, 3,23,28 in agreement with this study. The slow onset of median nerve blockade also accounted for the two failures in our cohort.…”

Section: Musculocutaneoussupporting

confidence: 92%

“…Therefore, hybrid BPB techniques 12,13 have been used to overcome this limitation but require relatively large volumes of local anaesthetic (40 to 50 ml) 12 . A variation of SeTB has also been described, in a dose-finding study, 28 for trunk injections but the sensorimotor block assessment did not include the suprascapular nerve 28 . More recently, an ‘intertruncal approach’ for supraclavicular BPB has been described, 2 which in theory should also produce anaesthesia of the entire upper extremity, but currently there are no such data 2,11 .…”

Section: Discussionmentioning

confidence: 99%

“…12 A variation of SeTB has also been described, in a dose-finding study, 28 for trunk injections but the sensorimotor block assessment did not include the suprascapular nerve. 28 More recently, an 'intertruncal approach' for supraclavicular BPB has been described, 2 which in theory should also produce anaesthesia of the entire upper extremity, but currently there are no such data. 2,11 That being said, the injection targets for the intertruncal approach can be challenging to define sonographically.…”

Section: Musculocutaneousmentioning

confidence: 99%

See 2 more Smart Citations

Ultrasound-guided selective trunk block: Evaluation of ipsilateral sensorimotor block dynamics, hemidiaphragmatic function and efficacy for upper extremity surgery. A single-centre cohort study

Sivakumar

Samy

Pakpirom

et al. 2022

European Journal of Anaesthesiology

View full text Add to dashboard Cite

BACKGROUND Selectively locating and blocking the individual trunks of the brachial plexus with small volumes of local anaesthetic, a selective trunk block (SeTB), may produce anaesthesia of the entire upper extremity except for the T2 dermatome.OBJECTIVE This study aimed to evaluate the effects of an ultrasound-guided (USG) SeTB on ipsilateral sensorimotor block dynamics, hemidiaphragmatic function, and efficacy as an all-purpose regional anaesthetic technique for upper extremity surgery.DESIGN Prospective cohort study.

show abstract

Section: Musculocutaneoussupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Musculocutaneousmentioning

confidence: 99%

See 1 more Smart Citation

Ultrasound-guided selective trunk block: Evaluation of ipsilateral sensorimotor block dynamics, hemidiaphragmatic function and efficacy for upper extremity surgery. A single-centre cohort study

Sivakumar

Samy

Pakpirom

et al. 2022

European Journal of Anaesthesiology

View full text Add to dashboard Cite

show abstract

“…Approaching the trunks of the brachial plexus under ultrasound guidance is a method that has recently been suggested as a block that provides anaesthesia similar to the interscalene block. [ 5 ] The availability of high-resolution ultrasound imaging has also made it possible to identify the phrenic nerve. [ 6 ] In the present volunteer-based, observational study, we aimed to compare the ultrasound distance between the brachial plexus and phrenic nerve at the classic interscalene point (interscalene groove along the cricoid cartilage) with the distance between the phrenic nerve and the upper trunk.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound measurement of the distance of the phrenic nerve from the brachial plexus at the classic interscalene point and upper trunk: A volunteer-based observational study

Sripriya,

Manisha Gupta,

Arthi

et al. 2023

Indian Journal of Anaesthesia

Self Cite

View full text Add to dashboard Cite

Background and Aims: The method of blocking the brachial plexus at the level of the upper trunk has been gaining popularity as a phrenic nerve–sparing alternative for interscalene block. We aimed to measure the distance of the phrenic nerve from the upper trunk and compare it with the distance between the phrenic nerve and the brachial plexus at the classic interscalene point by using ultrasound. Method: In this study, after ethical approval and trial registration, 100 brachial plexus of 50 volunteers were scanned from the emergence of the ventral rami and its course was traced to the supraclavicular fossa. The distance of the phrenic nerve from the brachial plexus was measured at two levels: the interscalene groove along the cricoid cartilage (classic interscalene block point) and from the upper trunk. The presence of anatomical variations of the brachial plexus, the classic traffic light sign, vessels across the plexus, and the location of the cervical oesophagus were also noted. Results: At the classic interscalene point, the C5 ventral ramus was observed to be just emerging or to have fully emerged from the transverse process. The phrenic nerve was identified in 86/100 (86%) of scans. The median (IQR) distance of the phrenic nerve from the C5 ventral ramus was 1.6 (1.1-3.9) mm and that of the phrenic nerve from the upper trunk was 17 (12-20.5) mm. Anatomical variations of the brachial plexus, the classic traffic light sign, and vessels across the plexus were seen in 27/100, 53/100, and 41/100 scans respectively. The oesophagus was consistently located on the left side of the trachea. Conclusions: There was a 10-fold increase in the distance of the phrenic nerve from the upper trunk when compared to that from the brachial plexus at the classic interscalene point.

show abstract

“…It has the advantage of the most widespread extent of sensory blockade among all the brachial plexus approaches and also single puncture technique because of the tight location of the plexus elements at this location. [ 1 ] The success of peripheral nerve blocks is usually assessed by sensory and motor function. But this method is subjective, time consuming and cannot be done in patients under general anaesthesia (GA), deep sedation or otherwise unable to provide feedback.…”

Section: Introductionmentioning

confidence: 99%

A study to evaluate the change in perfusion index as an indicator of successful ultrasound-guided supraclavicular block

Bhardwaj¹,

Lal²,

Malik³

et al. 2021

Indian J Anaesth

View full text Add to dashboard Cite

Background and Aims: Perfusion index (PI) is a new simple, objective and non-invasive method for evaluation of the success of central neuraxial and peripheral nerve blocks. So, we conducted a study with an aim to evaluate PI as an indicator for success of ultrasound-guided supraclavicular block (SCB). Methods: 65 patients of either sex, age 18–60 years, American Society of Anesthesiologists physical status I and II posted for upper limb surgery under ultrasound (US)-guided SCB were included. PI was recorded at baseline every 2 minutes till 10 minutes and then every 5 minutes till 30 minutes after block. PI ratio was calculated as the ratio between PI at 10 minutes and baseline PI. Sensory and motor blocks were assessed at 5-minutes intervals up to 30 minutes. Descriptive analysis was applied by mean and standard deviation for quantitative, frequency and proportion for categorical variables. Results: Mean PI increased continuously from baseline and reached the maximum at 10 minutes and then slightly decreased up to 30 minutes, but values at subsequent time intervals were quite high as compared to baseline. In case of successful blocks, median PI started increasing 2 minutes after the block and then increased in a linear fashion till 10 minutes, whereas in case of failed blocks, it only increased minimally. Conclusion: PI is an objective and faster indicator for evaluating success of US-guided SCB. A cut-off value of 3.25 for PI and 3.03 for PI ratio showed a fairly good ability with high sensitivity and specificity for predicting the success of SCB.

show abstract

Truncal injection brachial plexus block: A Description of a novel injection technique and dose finding study

Cited by 11 publications

References 25 publications

Ultrasound-guided selective trunk block: Evaluation of ipsilateral sensorimotor block dynamics, hemidiaphragmatic function and efficacy for upper extremity surgery. A single-centre cohort study

Ultrasound-guided selective trunk block: Evaluation of ipsilateral sensorimotor block dynamics, hemidiaphragmatic function and efficacy for upper extremity surgery. A single-centre cohort study

Ultrasound measurement of the distance of the phrenic nerve from the brachial plexus at the classic interscalene point and upper trunk: A volunteer-based observational study

A study to evaluate the change in perfusion index as an indicator of successful ultrasound-guided supraclavicular block

Contact Info

Product

Resources

About