Ultrasound-guided selective block of the medial brachial cutaneous and the intercostobrachial nerves for proximal arteriovenous fistula surgery

Varela, Víctor; Ruíz, Carlos Alberto; Montecinos, Sara; Sala‐Blanch, Xavier

doi:10.1136/rapm-2018-100298

Cited by 4 publications

(1 citation statement)

References 4 publications

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“…Data that support this teaching include older studies incorporating non-ultrasound-guided and distal approaches to the brachial plexus [1][2][3][4]. However, recent literature shows differences in opinion on the role of an ICBN block in preventing tourniquet pain [5][6][7].…”

Section: Introductionmentioning

confidence: 95%

Role of an Intercostobrachial Nerve Block in Alleviating Tourniquet Pain: A Randomized Clinical Trial

Le-Wendling¹,

Ihnatsenka²,

Jones³

et al. 2022

Cureus

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IntroductionTourniquet pain may have cutaneous and ischemic components. It is questionable whether blockade of a sensory nerve will help reduce ischemic pain. In addition, complete anesthesia of the axilla in the intercostobrachial nerve (ICBN) distribution is challenging to execute, and ICBN blockade has an inherently higher failure rate because of its variable anatomic location and source of innervation. We sought to determine the utility of an ICBN block for the prevention of tourniquet pain. MethodsWe conducted a single-center randomized controlled trial at a major academic medical center involving patients scheduled to undergo distal upper extremity surgery under ultrasound-guided supraclavicular brachial plexus block. Forty patients were randomized to receive an additional ICBN block or no ICBN block, with 22 allocated to the intervention and 18 to control. We collected data on the incidence of tourniquet pain and systemic anesthetic requirements. ResultsInitial contingency analysis examining the relationship between ICBN block placement and the development of pain using the two-tailed Fisher exact test failed to show that the presence or absence of ICBN block was associated with the development of tourniquet pain. χ 2 analysis failed to show that tourniquet time was significantly related to the development of tourniquet pain. ConclusionsThe overall incidence of tourniquet pain in the setting of a dense supraclavicular brachial plexus block for surgical anesthesia was low even without an ICBN block and even with tourniquet times greater than 90 min. Tourniquet pain was easily managed with small amounts of systemic analgesics.

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Section: Introductionmentioning

confidence: 95%

Role of an Intercostobrachial Nerve Block in Alleviating Tourniquet Pain: A Randomized Clinical Trial

Le-Wendling¹,

Ihnatsenka²,

Jones³

et al. 2022

Cureus

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Modified serratus plane block for axillary lymph node dissection

Jajur

Manickam

2021

Journal of Clinical Anesthesia

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Usefulness of high-resolution ultrasound for small nerve blocks: visualization of intercostobrachial and medial brachial cutaneous nerves in the axillary area

Varela

Ruíz

Pomés

et al. 2019

Reg Anesth Pain Med

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IntroductionHigh-resolution ultrasound (HRU) allows one to identify small nerves, but in the clinical setting, intercostobrachial nerve (ICBN) and medial brachial cutaneous nerve (MBCN) are not identified with conventional portable ultrasound (CPU) devices. The aim of this study is to identify both nerves and describe their relation with specific anatomical structures which could be easily identified with the ultrasound devices available in the clinical setting.Methods21 healthy patients were scanned using HRU bilaterally in the axillary area located over the conjoint tendon to find the ICBN and MBCN and describe their anatomic relations. 5 fresh cadavers were used to validate the previous anatomical findings. ICBN and MBCN ultrasound-guided block was performed with 5 mL of methylene blue and iodine contrast, and the distribution was assessed by both CT scan and dissection.ResultsICBN and MBCN were identified in all cases. The average distance of the ICBN branches to the artery was 35±6 mm in men and 27±5 mm in women. Constant identification of the muscle–tendon junction of the latissimus dorsi muscle with respect to the location of the branches of the ICBN nerve was observed. Dissection and CT scan confirmed these findings.ConclusionHRU is a useful tool to identify ICBN and MBCN nerves, and to describe structures which can be easily identified with CPU use in the clinical setting.

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Ultrasound-guided selective block of the medial brachial cutaneous and the intercostobrachial nerves for proximal arteriovenous fistula surgery

Cited by 4 publications

References 4 publications

Role of an Intercostobrachial Nerve Block in Alleviating Tourniquet Pain: A Randomized Clinical Trial

Role of an Intercostobrachial Nerve Block in Alleviating Tourniquet Pain: A Randomized Clinical Trial

Modified serratus plane block for axillary lymph node dissection

Usefulness of high-resolution ultrasound for small nerve blocks: visualization of intercostobrachial and medial brachial cutaneous nerves in the axillary area

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