Ultrasound-guided Supraclavicular Block: What Is Intraneural?

Abstract

disrupted cytoskeleton, absence of normal intracellular ion concentrations, and different membrane tension compared with the whole cell.In short, there is no single ideal in vitro system for replacing the human neuromuscular junction. However, we believe that by using comparative in vitro pharmacology one can qualitatively describe clinically relevant pharmacological interactions on the cellular level. This is possible without resolving the exact distribution between multiple desensitized states.

Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound‐guided interscalene and supraclavicular nerve blocks*

“…As there are no agreed criteria by which ultrasound can be used to determine whether an intraneural injection is in neuronal connective tissue or neural fascicles [10], we considered needle placement in the sub epineurium followed by previously described criteria such as neuronal swelling or halo during injection to identify intraneural injection [11]. A third investigator was appointed to resolve disagreement between the initial two reviewers.…”

Ultrasound brachial plexus anesthesia and analgesia for upper extremity surgery

“…In a letter to the editor, it was indicated that extraneural fascial layers surrounding the brachial plexus in the supraclavicular area is routinely breached during performance of a supraclavicular block [36]. This fascial layer is intentionally violated under real-time ultrasoundguided supraclavicular blockade and local anesthetic injected lateral to the subclavian artery, above the first rib and in between trunks/divisions of the plexus (assumed to be extraneural).…”

Ultrasound and nerve stimulator guided peripheral nerve blocks of the upper and lower limbs

“…Pleksus je lokalizovan 2,5 cm lateralno od lateralnog pripoja m. sternocleidomastoideusa i igla (25-27 G, 50 mm) se usmerava anteroposteriorno i blago kaudalno, korišćenjem nervnog stimulatora (0,2-0,5 mA, 0,1 ms, 1 Hz), može se videti odgovarajući mišićni odgovor ruke. Ubrizgava se 25-35 ml lokalnog anestetika 29 (Slika 3). Ukoliko se blok izvodi pod kontrolom ultrazvuka, pacijent je takođe u polusedećem položaju, sa glavom rotiranom u suprotnu stranu i ultrazvučna linearna sonda se postavlja transverzalno na sredinu klavikule, a cilj je identifikacija a. subclavie, prvog rebra i pleure.…”