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Posterior parasagittal in-plane ultrasound-guided infraclavicular brachial plexus block-a case series.

Beh ZY, Hasan MS, Lai HY, Kassim NM, Md Zin SR, Chin KF - BMC Anesthesiol (2015)

Bottom Line: The brachial plexus at the infraclavicular level runs deeper compared to its course proximally, giving rise to impaired needle visualisation due to the steep angle of needle insertion with the current ultrasound-guided approach.All patients had 100 % success rate.There were no adverse events encountered in this study.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. michaelbzy@gmail.com.

ABSTRACT

Background: The brachial plexus at the infraclavicular level runs deeper compared to its course proximally, giving rise to impaired needle visualisation due to the steep angle of needle insertion with the current ultrasound-guided approach. A new posterior parasagittal in-plane ultrasound-guided infraclavicular approach was introduced to improve needle visibility. However no further follow up study was done.

Methods: We performed a case series and a cadaveric dissection to assess its feasibility in a single centre, University of Malaya Medical Centre, Kuala Lumpur, Malaysia from November 2012 to October 2013. After obtaining approval from the Medical Ethics Committee, University Malaya Medical Centre, 18 patients undergoing upper limb surgery were prospectively recruited. A cadaveric dissection was also performed. The endpoints of this study were the success rate, performance time, total anaesthesia-related time, quality of anaesthesia and any incidence of complications.

Results: All patients had 100 % success rate. The imaging time, needling time and performance time were comparable with previously published study. There were no adverse events encountered in this study. The cadaveric dissection revealed a complete spread of methylene blue dye over the brachial plexus.

Conclusion: This study demonstrated that the posterior parasagittal in-plane approach is a feasible and reliable technique with high success rate. Future studies shall compare this technique with the conventional lateral parasagittal in-plane approach.

Trial registration: ClinicalTrials.gov NCT02312453 . Registered on 8 December 2014.

No MeSH data available.


Related in: MedlinePlus

Proportion of patients with motor paralysis (score of 2) according to time in distributions of nerves. The musculocutaneous nerve achieved fastest onset of motor paralysis, followed by radial nerve. The ulnar was third and median nerve tend to be the slowest in achieving motor paralysis
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Fig4: Proportion of patients with motor paralysis (score of 2) according to time in distributions of nerves. The musculocutaneous nerve achieved fastest onset of motor paralysis, followed by radial nerve. The ulnar was third and median nerve tend to be the slowest in achieving motor paralysis

Mentions: From the Figs. 3 and 4, the posterior approach exhibited similar pattern of sensory and motor blocks profile. The musculocutaneous nerve was the fastest to achieve sensory anaesthesia and motor paralysis, followed by radial nerve, ulnar nerve and median nerve tend to be the slowest to achieve full blockade.Fig. 3


Posterior parasagittal in-plane ultrasound-guided infraclavicular brachial plexus block-a case series.

Beh ZY, Hasan MS, Lai HY, Kassim NM, Md Zin SR, Chin KF - BMC Anesthesiol (2015)

Proportion of patients with motor paralysis (score of 2) according to time in distributions of nerves. The musculocutaneous nerve achieved fastest onset of motor paralysis, followed by radial nerve. The ulnar was third and median nerve tend to be the slowest in achieving motor paralysis
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4509774&req=5

Fig4: Proportion of patients with motor paralysis (score of 2) according to time in distributions of nerves. The musculocutaneous nerve achieved fastest onset of motor paralysis, followed by radial nerve. The ulnar was third and median nerve tend to be the slowest in achieving motor paralysis
Mentions: From the Figs. 3 and 4, the posterior approach exhibited similar pattern of sensory and motor blocks profile. The musculocutaneous nerve was the fastest to achieve sensory anaesthesia and motor paralysis, followed by radial nerve, ulnar nerve and median nerve tend to be the slowest to achieve full blockade.Fig. 3

Bottom Line: The brachial plexus at the infraclavicular level runs deeper compared to its course proximally, giving rise to impaired needle visualisation due to the steep angle of needle insertion with the current ultrasound-guided approach.All patients had 100 % success rate.There were no adverse events encountered in this study.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. michaelbzy@gmail.com.

ABSTRACT

Background: The brachial plexus at the infraclavicular level runs deeper compared to its course proximally, giving rise to impaired needle visualisation due to the steep angle of needle insertion with the current ultrasound-guided approach. A new posterior parasagittal in-plane ultrasound-guided infraclavicular approach was introduced to improve needle visibility. However no further follow up study was done.

Methods: We performed a case series and a cadaveric dissection to assess its feasibility in a single centre, University of Malaya Medical Centre, Kuala Lumpur, Malaysia from November 2012 to October 2013. After obtaining approval from the Medical Ethics Committee, University Malaya Medical Centre, 18 patients undergoing upper limb surgery were prospectively recruited. A cadaveric dissection was also performed. The endpoints of this study were the success rate, performance time, total anaesthesia-related time, quality of anaesthesia and any incidence of complications.

Results: All patients had 100 % success rate. The imaging time, needling time and performance time were comparable with previously published study. There were no adverse events encountered in this study. The cadaveric dissection revealed a complete spread of methylene blue dye over the brachial plexus.

Conclusion: This study demonstrated that the posterior parasagittal in-plane approach is a feasible and reliable technique with high success rate. Future studies shall compare this technique with the conventional lateral parasagittal in-plane approach.

Trial registration: ClinicalTrials.gov NCT02312453 . Registered on 8 December 2014.

No MeSH data available.


Related in: MedlinePlus