M-mode Ultrasound Scan as a Potential Alternative Technique for Monitoring Uterine Contractions in Obese Patients

Objectives(1) To review management of a series of women referred for removal of intrauterine contraception (IUC) with non-visible threads. (2) To establish whether the device was likely to have been placed at the fundus at insertion. (3) To document removal success rates in a community sexual health (CSH) setting.Study designA retrospective review of a series of 76 women seen by the author between April 2016 and October 2017 in a specialist CSH clinic for removal of IUC with non-visible threads.ResultsAfter ultrasound scan (USS) assessment 67 women underwent a removal procedure. Sixty-two devices (92.5%) were successfully removed. Uterine instrumentation beyond the internal os was required in 43 removals, enabling comparison of uterine cavity length with the length of IUC and threads. Such comparison suggested 39/43 (91%) devices were not fundal at insertion and that non-visible threads were likely to have been caused by the device moving to the fundus post-insertion under the influence of uterine contractions, leading to retraction of the threads.ConclusionsRemoval of IUC with non-visible threads can be successfully done in a CSH setting with ultrasound availability. Non-fundal placement of IUC at insertion is likely to be a significant cause of non-visible threads.

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Subcoracoid tunnel block as an alternative infraclavicular brachial plexus approach -a case series-

Korean Journal of Anesthesiology ◽

10.4097/kja.20372 ◽

2020 ◽

Vol 73 (5) ◽

pp. 450-454 ◽

Cited By ~ 1

Author(s):

Sandeep Diwan ◽

Divya Sethi ◽

Avinash Gaikwad ◽

Parag Sancheti ◽

Abhijit Nair

Keyword(s):

Brachial Plexus ◽

Case Series ◽

Alternative Technique ◽

Ultrasound Scan ◽

Ultrasound Guided ◽

Magnetic Resonance Neurography ◽

New Approach ◽

Needle Pass ◽

Elbow Surgery ◽

Infraclavicular Block

Background: Magnetic resonance neurography shows the brachial plexus cords in the subcoracoid tunnel beneath the pectoralis minor. With an ultrasound scan along the brachial line, the brachial plexus cords in the subcoracoid tunnel can be targeted using an in-plane needle approach. We describe this new approach to the infraclavicular block called the “subcoracoid tunnel block.”Case: Twenty patients were administered with the ultrasound-guided subcoracoid tunnel block for the below-elbow surgery. The contact of the needle tip with cords was visible in all 20 patients. With neurostimulation, the posterior cord was identified in 11 (55%) and medial cord in 9 (45%) patients on the first needle pass. The subcoracoid tunnel block was successful in 16 patients (80%). Conclusions: Our case series shows that the subcoracoid tunnel block is an excellent alternative technique for the infraclavicular block. Its advantages include better needle-cord visibility and easy identification of the brachial plexus cords.

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