Ultrasound-guided costoclavicular block as an alternative for upper limb anesthesia in obese patients

Silva, Grazielle Rodrigues; Borges, Danielle Gonçalves; Lopes, Iuri Ferreira; Ruzi, Roberto Araújo; Costa, Paulo Ricardo Rabello de Macedo; Mandim, Beatriz Lemos da Silva

doi:10.1016/j.bjane.2019.09.003

Cited by 6 publications

(6 citation statements)

References 8 publications

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“…At these distal segments of the brachial plexus, medial cords were visualized posterior to the artery (18%) and between the artery and the vein (35%). 8 Brenner et al demonstrated the change of the positioning of the cords relative to the artery using USG scout scanning from proximal to distal. 20 It was also demonstrated in our study with cadaver dissections ( Figure 1 , Figure 2 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The need for supplemental blocks in single versus triple injections in infraclavicular brachial plexus blocks with a medial approach: a clinical and anatomic study

Gürbüz

Tuncay

2020

Brazilian Journal of Anesthesiology (English Edition)

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Section: Discussionmentioning

confidence: 99%

“…On the other hand, when compared with the lateral approach, the medial approach was reported to be faster, gave a better proximal block, and the brachial plexus could be visualized easier because it was closer to the surface than in the lateral approach. 8. , 9.…”

Section: Introductionmentioning

confidence: 99%

The need for supplemental blocks in single versus triple injections in infraclavicular brachial plexus blocks with a medial approach: a clinical and anatomic study

Gürbüz

Tuncay

2020

Brazilian Journal of Anesthesiology (English Edition)

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“…We initially planned to perform ICB or CCB because of the relatively low reported incidence of HDP. Although CCB was reported to be more easily visualized than the traditional ICB approach [ 3 ] because of the more superficial location of the brachial nerve cords and was reported as a successful alternative method for upper limb surgery in an obese patient, [ 15 ] both methods failed due to inadequate visualization. Poor image quality and a large trajectory angle might affect the safety and effectiveness of regional anesthesia, resulting in malposition of the needle or catheter, leading to complications such as intravascular injection, intraneural injection, and pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

Dyspnea induced by hemidiaphragmatic paralysis after ultrasound-guided supraclavicular brachial plexus block in a morbidly obese patient

et al. 2022

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Rationale: Hemidiaphragmatic paralysis (HDP) is a frequent complication of the brachial plexus block, caused by unintentional blockade of ipsilateral phrenic nerve. HDP did not rise enough alarm and attention to most anesthesiologists, because most patients with no coexisting comorbid diseases are asymptomatic and able to tolerate it. However, it may cause severe respiratory complication for patients with preexisting compromised cardiorespiratory function. Patient concerns: A 67-year-old woman with morbidly obesity was planned to receive opening reduction and internal fixation of right humeral shaft fracture under regional anesthesia considering less respiratory and cardiovascular system interference compared with general anesthesia. Diagnoses: After ultrasound guided supraclavicular brachial plexus block, the patient developed severe hypoxia and hypercapnia.Unintentional block of phrenic nerve and diaphragm paralysis was diagnosed by diaphragm ultrasound, which was considered as the main reason of severe hypoxia. Interventions: It led to a conversion from regional anesthesia to general anesthesia with endotracheal intubation for patient's safety and smooth operation. Outcomes: The unintentional phrenic nerve block leads to a prolonged ventilation time, length of stay in intensive care unit and length of stay in hospital. Lessons: This case report highlights the risk of diaphragm paralysis in morbidly obese patients. Though new diaphragm sparing brachial plexus block (BPB) methods were developed intended to reduce the risk of HDP, no approaches could absolutely spare phrenic nerve involvement. Therefore, clinicians should always consider the risk of HDP associated with BPBs. For each individual, a detailed preoperative evaluation and sufficient preparation are paramount to avoid serious complications.

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“…Though the costoclavicular approach has been a recent nomenclature, proximal, medial, vertical approaches essentially describe the same location and there have been multiple studies evaluating the block characteristics of these approaches. 9, 11, 15, 25 Results from past studies comparing the two techniques have been equivocal. Some technical reports have led us to believe that medial approaches may be better and quicker for infraclavicular block.…”

Section: Discussionmentioning

confidence: 99%

Paracoracoid versus Costoclavicular Approach to Infraclavicular Block: A Prospective, Two Arm, Parallel design, Single-centre Randomized Controlled Trial

Brown

Magsaysay

Bureau

et al. 2020

Preprint

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Introduction: Paracoracoid approach to the brachial plexus block is the conventional infraclavicular technique for upper limb surgeries. In this approach, the ultrasound transducer is placed in the parasagittal plane below the clavicle, medial to the coracoid process. In this view, three cords are separated from each other and are rarely visualized in a single ultrasound window. In the costoclavicular approach, the ultrasound transducer is placed parallel to and below the clavicle. In this view, the cords are clustered together, at a more superficial level. We conducted a randomized controlled trial to compare these two infraclavicular brachial plexus approaches. Methods: Seventy patients were randomized to receive either a paracoracoid or costoclavicular infraclavicular block. Both groups received 35 ml of 0.5% ropivacaine under ultrasound guidance. The primary outcome was sensory block onset time while secondary outcomes included performance times, complications during block insertion (paresthesia, vascular puncture, pleural puncture), block failure, patient satisfaction, and postoperative complications. Telephone follow-up was done 24 h and 7 days later. Results: Sensory block onset time was significantly shorter in the paracoracoid group 18.7 (4.4) min versus 22.2 (6.2) min (p=0.045). Block success at 30 minutes was the same between both groups. There was no difference in any secondary outcomes. Conclusion: This randomized controlled trial demonstrated that the novel costoclavicular approach to the infraclavicular brachial plexus block had similar procedure time, block success and similar complication rates for upper limb surgery when compared to the traditional paracoracoid technique but resulted in longer sensory block onset time.

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Ultrasound-guided costoclavicular block as an alternative for upper limb anesthesia in obese patients

Cited by 6 publications

References 8 publications

The need for supplemental blocks in single versus triple injections in infraclavicular brachial plexus blocks with a medial approach: a clinical and anatomic study

The need for supplemental blocks in single versus triple injections in infraclavicular brachial plexus blocks with a medial approach: a clinical and anatomic study

Dyspnea induced by hemidiaphragmatic paralysis after ultrasound-guided supraclavicular brachial plexus block in a morbidly obese patient

Paracoracoid versus Costoclavicular Approach to Infraclavicular Block: A Prospective, Two Arm, Parallel design, Single-centre Randomized Controlled Trial

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