Ultrasound-guided retroclavicular approach infraclavicular brachial plexus block for upper extremity emergency procedures

Luftig, Josh; Mantuani, Daniel; Herring, Andrew A.; Nagdev, Arun

doi:10.1016/j.ajem.2017.01.028

Cited by 17 publications

(11 citation statements)

References 18 publications

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“…[ 18 ] Some authors have stated that by keeping the needle close to the under surface of the clavicle, the block needle passes through only muscle and loose connective tissue and avoids pneumothorax if not directed posteriorly. [ 2 7 ] Supraclavicular nerves too may be trespassed by this approach, unlike our dissection findings. [ 19 ]…”

Section: Discussionmentioning

confidence: 62%

“…Infraclavicular brachial plexus block (ICBPB) is a reliable method of providing anesthesia to the upper limb distal to the elbow with a lesser incidence of diaphragmatic paralysis, pneumothorax or Horner's syndrome compared to other methods of brachial plexus block (BPB), and hence safe even in patients with respiratory comorbidities. [ 1 2 ] The ultrasound-guided infraclavicular brachial plexus block (USG-ICBPB) is administered by one of four approaches—the traditional (lateral infraclavicular fossa or LICF), costoclavicular medial to lateral (CML), costoclavicular lateral to medial (CLM), and retroclavicular (R), each with their advantages and pitfalls.…”

Section: Introductionmentioning

confidence: 99%

“…The LICF approach has the disadvantage of a steeper trajectory of needle resulting in diminished needle visibility, thereby increasing the procedural time and increased number of passes which in turn increases the risk of needle–nerve contact. [ 2 ] The sonoanatomy of the CLM approach was described by Sala-Blanch X et al . as brachial plexus cords clustered lateral to the axillary artery (AA) and with consistent relationship to one another.…”

Section: Introductionmentioning

confidence: 99%

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A cadaver study of four approaches of ultrasound-guided infraclavicular brachial plexus block

et al. 2020

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Background and Aims: The ultrasound-guided infraclavicular brachial plexus block (USG ICBPB) is a popular technique for forearm surgeries distal to the elbow. Our study details the ultrasound (US) characteristics of this block and the structures encountered by the needle in four approaches to the infraclavicular area – lateral infraclavicular (LICF), costoclavicular medial to lateral (CML) and lateral to medial (CLM) and retroclavicular (R) by anatomical dissection. Methods: USG ICBPB was performed in 10 cadavers—5 on the right side and 5 on the left side by each of four approaches and with an 18 gauge Tuohy needle kept in situ , and US characteristics were noted. Anatomical dissection was done and important structures were described in detail. Results: Needle tip and shaft visibility were least with LICF approach and best in R approach. Needle angle correlated with chest and neck circumference in LICF and CML groups. During dissection, in all approaches, neurovascular structures have been observed in the near vicinity of the needle, especially the thoracoacromial artery (TAA) or its branches. In the R approach, the 'blind spot' behind the clavicle is an area where neurovascular structures were present. Conclusion: The R approach gives better visibility of needle shaft beyond the clavicle, but the clavicle acts as a 'blind-spot' for the US beam obliterating important neurovascular structures. The various neurovascular structures the needle traverses or in its immediate vicinity, do not necessarily make the CML, CLM or R approach any better than the LICF approach.

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Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A cadaver study of four approaches of ultrasound-guided infraclavicular brachial plexus block

et al. 2020

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“…Many of the patients who can potentially benefit from UGRA such as patients with acute fractures, abscesses in need of incision and drainage, exacerbations of chronic pain, etc., are seen by advanced practice providers. Including them in training and skill development can be an important part of developing broad integration of UGRA into standard ED practice …”

Section: Ultrasound‐guided Regional In Anesthesia: It Is Not Just Formentioning

confidence: 91%

Bringing Ultrasound‐guided Regional Anesthesia to Emergency Medicine

Herring

2017

AEM Education and Training

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“…Some technical refinements have been described attempting to reduce the chance of iatrogenic injury in cases of anesthetic brachial plexus block [98,99]. The use of ultrasonography can be of invaluable help [100]. Some recommendations on patient positioning have also been forwarded [44].…”

Section: Future Treatment Possibilitiesmentioning

confidence: 99%