Efficacy of ultrasound imaging for differential diagnosis of cervical swelling after brachial plexus block for shoulder arthroscopy

Background and objectivesThe paraneural sheath is a multilayered network of collagen fibers that surround the brachial plexus. Currently, there are no sonographic data on the paraneural sheath of the brachial plexus, which this study aimed to evaluate.MethodsUltrasound imaging datasets of 100 patients who received a costoclavicular brachial plexus block, using high-definition ultrasound imaging, were retrospectively reviewed. Video files, representing sonograms before and after the local anesthetic injection, from the costoclavicular space and lateral infraclavicular fossa were collated and reviewed by three experienced anesthesiologists. Frequency (yes/no) of ultrasound visualization of the paraneural sheath, septum, and the anterior and posterior compartments was assessed. Representative sonograms from the costoclavicular space and lateral infraclavicular fossa were visually correlated with archived cadaver microanatomic sections from the same location.ResultsDatasets of the 98 patients who achieved surgical anesthesia were evaluated. The paraneural sheath, septum, and the anterior and posterior compartments were visualized in 17.3%, 7.1%, 5.1% and 5.1%, respectively, at the costoclavicular space before the brachial plexus block; this contrasts (p<0.001) with their visibility post-block (94.9%, 75.5%, 75.5% and 75.5%, respectively). At the lateral infraclavicular fossa, the corresponding visibility of these structures post-block were 67.7%, 81.5%, 81.5% and 81.5%, respectively. Ultrasound images of the paraneural sheath and septum correlated well with that in the cadaver microanatomic sections.ConclusionWe have demonstrated the paraneural sheath and fascial compartments surrounding the cords of the brachial plexus at the costoclavicular space and lateral infraclavicular fossa using high-definition ultrasound imaging.Trial registration numberClinicalTrials.gov Registry (NCT04370184), (https://www.clinicaltrials.gov/).

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Evaluation of ultrasound guided interscalene brachial plexus block versus general anesthesia versus combination of both techniques in shoulder arthroscopy. A randomized clinical trial

European Journal of Anaesthesiology ◽

10.1097/00003643-201306001-00371 ◽

2013 ◽

Vol 30 ◽

pp. 119-119

Author(s):

M. D. Schmittner ◽

G. Loosen ◽

C. Weiss ◽

L. J. Lehmann

Keyword(s):

Clinical Trial ◽

Brachial Plexus ◽

General Anesthesia ◽

Randomized Clinical Trial ◽

Brachial Plexus Block ◽

Shoulder Arthroscopy ◽

Ultrasound Guided ◽

Interscalene Brachial Plexus Block ◽

Plexus Block

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Blood pressure response to combined general anaesthesia/interscalene brachial plexus block for outpatient shoulder arthroscopy

BMC Anesthesiology ◽

10.1186/1471-2253-14-50 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 8

Author(s):

Hauke Janssen ◽

Roland von Stosch ◽

Rupert Pöschl ◽

Benedikt Büttner ◽

Martin Bauer ◽

...

Keyword(s):

Blood Pressure ◽

Brachial Plexus ◽

General Anaesthesia ◽

Brachial Plexus Block ◽

Blood Pressure Response ◽

Shoulder Arthroscopy ◽

Pressure Response ◽

Interscalene Brachial Plexus Block ◽

Plexus Block

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Comparative evaluation of regional blockades during arthroscopic shoulder surgery

Regional Anesthesia and Acute Pain Management ◽

10.17816/1993-6508-2018-12-4-242-249 ◽

2018 ◽

Vol 12 (4) ◽

pp. 242-249

Author(s):

K. S. Trukhin ◽

Dmitry V. Zabolotskii ◽

V. A. Koriachkin ◽

O. V. Kuleshov ◽

A. A. Cherednichenko ◽

...

Keyword(s):

Brachial Plexus ◽

Rating Scale ◽

Brachial Plexus Block ◽

Shoulder Arthroscopy ◽

Arthroscopic Surgery ◽

Neurological Complications ◽

Patient Comfort ◽

Narcotic Analgesics ◽

Interscalene Brachial Plexus Block ◽

Plexus Block

Objective: To evaluate the effectiveness of interscalene brachial plexus block versus combined suprascapular and axillary nerves block for shoulder arthroscopy. Methods: In this prospective study 174 patients were operated on the shoulder joint by the arthroscopic method under combined anesthesia. In the 1st group (n=96), for the purpose of analgesia, patients got interscalene brachial plexus block; in the 2nd group (n=78), patients received suprascapular and axillary nerves block. Ultrasound visualization and neurostimulation were used in both groups. Recorded the time from the start of blockade to the start of the operation, as well as the duration of the sensory and motor blockade. The intensity of postoperative pain was assessed with a 10-point Numeric rating scale, the need for additional analgesia, the quality of night sleep, and patient comfort. Neurological complications were also recorded. Results: There were no differences in the time from the admit patients to the operating room and before the start surgery. The analgesic effect in the early postoperative period in the 1st group was higher, but by the end of the first day there was no statistical difference between the groups in the intensity of the pain syndrome. Intake of non-narcotic and narcotic analgesics was higher in the 2nd group. Complications were noted only for the 1st group: diaphragm paresis in 6 (6.25%) patients, in 2 (2.08%) recurrent laryngeal nerve blockade. Satisfaction with postoperative analgesia was 100% in patients of the 2nd group. The choice of regional anesthesia for arthroscopic interventions on the shoulder did not affect the length of hospitalization. Conclusion: Selective anesthesia of the suprascapular and axillary nerves during shoulder arthroscopic surgery is an alternative of interscalene brachial plexus block; it is not associated by respiratory and neurological complications; does not violate movements in the distal upper limb, reduces psychological discomfort and anxiety of patients.

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