scholarly journals Variations in Subscapularis Muscle Innervation—A Report on Case Series

Medicina ◽  
2020 ◽  
Vol 56 (10) ◽  
pp. 532
Author(s):  
Martin Siwetz ◽  
Niels Hammer ◽  
Benjamin Ondruschka ◽  
David C. Kieser
Keyword(s):  
Brachial Plexus ◽  
Case Series ◽  
Previous Literature ◽  
Myotendinous Junction ◽  
Imaging Procedures ◽  
Nerve Blocks ◽  
Subscapularis Muscle ◽  
Muscle Innervation ◽  
Thoracodorsal Nerve

Background and objectives: The subscapularis muscle is typically innervated by two distinct nerve branches, namely the upper and lower subscapular nerve. These usually originate from the posterior cord of the brachial plexus. A large number of variations have been described in previous literature. Materials and Methods: Dissection was carried out in 31 cadaveric specimens. The frequency of accessory subscapular nerves was assessed and the distance from the insertion points of these nerves to the myotendinous junction was measured. Results: Accessory subscapular nerves were found in three cases (9.7%). According to their origin from the posterior cord of the brachial plexus proximal to the thoracodorsal nerve all three nerves were identified as accessory upper subscapular nerves. No accessory lower subscapular nerves were found. Conclusion: Accessory nerves occur rather commonly and need to be considered during surgery, nerve blocks, and imaging procedures.

Nerve Graft Length and Recovery of Elbow Flexion Muscle Strength in Patients With Traumatic Brachial Plexus Injuries: Case Series

2021 ◽  
Author(s):  
Mariano Socolovsky ◽  
Gilda di Masi ◽  
Gonzalo Bonilla ◽  
Ana Lovaglio ◽  
Kartik G Krishnan
Keyword(s):  
Brachial Plexus ◽  
Case Series ◽  
Target Function ◽  
Elbow Flexion ◽  
Nerve Graft ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Nerve Reconstruction ◽  
Muscle Recovery ◽  
Spinal Accessory

Abstract BACKGROUND Traumatic brachial plexus injuries cause long-term maiming of patients. The major target function to restore in complex brachial plexus injury is elbow flexion. OBJECTIVE To retrospectively analyze the correlation between the length of the nerve graft and the strength of target muscle recovery in extraplexual and intraplexual nerve transfers. METHODS A total of 51 patients with complete or near-complete brachial plexus injuries were treated with a combination of nerve reconstruction strategies. The phrenic nerve (PN) was used as axon donor in 40 patients and the spinal accessory nerve was used in 11 patients. The recipient nerves were the anterior division of the upper trunk (AD), the musculocutaneous nerve (MC), or the biceps branches of the MC (BBs). An index comparing the strength of elbow flexion between the affected and the healthy arms was correlated with the choice of target nerve recipient and the length of nerve grafts, among other parameters. The mean follow-up was 4 yr. RESULTS Neither the choice of MC or BB as a recipient nor the length of the nerve graft showed a strong correlation with the strength of elbow flexion. The choice of very proximal recipient nerve (AD) led to axonal misrouting in 25% of the patients in whom no graft was employed. CONCLUSION The length of the nerve graft is not a negative factor for obtaining good muscle recovery for elbow flexion when using PN or spinal accessory nerve as axon donors in traumatic brachial plexus injuries.

Ultrasound-guided approach for axillary brachial plexus, femoral nerve, and sciatic nerve blocks in dogs

2010 ◽  
Vol 37 (2) ◽  
pp. 144-153 ◽  
Author(s):  
Luis Campoy ◽  
Abraham J Bezuidenhout ◽  
Robin D Gleed ◽  
Manuel Martin-Flores ◽  
Robert M Raw ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Brachial Plexus ◽  
Femoral Nerve ◽  
Ultrasound Guided ◽  
Nerve Blocks

scholarly journals Anaesthesia and Postoperative Analgesia Performed by Insertion of a Perineural Catheter at the Brachial Plexus Site - Case Series

2015 ◽  
Vol 61 (3) ◽  
pp. 241-244
Author(s):  
Lazar Alexandra ◽  
Szederjesi Janos ◽  
Copotoiu Sanda Maria ◽  
Simon Noemi Szidonia ◽  
Badea Iudita ◽  
...  
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Brachial Plexus ◽  
Postoperative Analgesia ◽  
Postoperative Period ◽  
Case Series ◽  
Postoperative Pain Management ◽  
Perineural Catheter ◽  
Plexus Block ◽  
Systemic Drug

Abstract Postoperative pain management is of major importance and the existence of a device that ensures a good analgesia in the immediate postoperative period and also removes the side effects of the systemic drugs, is becoming a necessity. Objectives: The goal was to obtain a good quality anaesthesia and also a good postoperative analgesia by inserting a perineural catheter at the brachial plexus site. Material and method: This study included adult patients who underwent brachial plexus anaesthesia through a perineural catheter inserted at the brachial plexus site. The perineural catheter was introduced by ultrasound guidance with neurostimulation control. After insertion, a quantity of a an-aesthetic admixture of 0.4mg/kg is administered. The anaesthetic admixture contained Ropivacaine and Lidocaine, equimolar concentration of 0.5% In the postoperative period, the analgesia was ensured trough the already installed catheter. The analgesic mixture contained Ropivacaine and Lidocaine, equivalent concentrations of 0.25%. The administration rate was 5 ml every 4 hours, starting 6 hours postoperatively. Results: The anaesthesia, obtained through the perineural catheter, was a good quality anaesthesia ensuring both, good sensory and motor block. The feedback regarding postoperative analgesia was positive, this type of pain management being efficient and without the systemic drug side effects. This approach of brachial plexus block was accepted easily by the patients and was rated as a very satisfactory method. Conclusions: The insertion of a perineural catheter for anaesthesia and postoperative analgesia represents a safe and efficient method of achieving both analgesia and anaesthesia.

A STUDY TO COMPARE THE EFFICACY OF BUPIVACAINE ALONE AND BUPIVACAINE PLUS DEXAMETHASONE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

2021 ◽  
pp. 1-3
Author(s):  
Rupesh Kumar Mishra ◽  
Rahul Kumar ◽  
Chandeshwar Choudhary ◽  
Debarshi Jana
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Age Groups ◽  
Onset Time ◽  
Nerve Blocks ◽  
Anesthetic Care ◽  
Duration Of Surgery ◽  
Supraclavicular Brachial Plexus Block ◽  
Supraclavicular Block ◽  
Plexus Block

Peripheral nerve blocks can be used for anesthesia, postoperative analgesia, diagnosis and treatment of chronic pain disorders. Skilful application of peripheral nerveblockade broadens the anesthesia provider's range of options in providing optimal anesthetic care. These techniques can be used in all age groups, with appropriate selection and sedation. Present prospective, randomized, double blinded study was conducted at Department of Anaesthesiology, SKMCH, Muzaffarpur, Bihar. Total Sixty consecutive adult patients undergoing upper limb orthopaedic surgeries under supraclavicular block were studied. The patients were drafted in the study after obtaining written informed consent from them. Patients divided in two groups : No statistically signicant difference in the demographic parameters and duration of surgery between the two groups was noted. We, therefore, conclude that addition of 8 mg dexamethasone to bupivacaine 0.25% solution in supraclavicular brachial plexus block. 1) Prolongs the duration of sensory and motor blockade. 2) Reduces the requirement of rescue analgesic in postoperative period. 3) Has no effect on the onset time of sensory and motor blockadc

Occipital Nerve Blocks for Relief of Headaches in Patients With Ventriculoperitoneal Shunts: A Case Series

2019 ◽  
Vol 34 (11) ◽  
pp. 674-678 ◽  
Author(s):  
Eugene Kim ◽  
Giovanni Cucchiaro
Keyword(s):  
Pediatric Patients ◽  
Case Series ◽  
Therapeutic Interventions ◽  
Shunt Revision ◽  
Occipital Neuralgia ◽  
Pulsed Radiofrequency ◽  
Nerve Blocks ◽  
Ventriculoperitoneal Shunts ◽  
Occipital Nerve ◽  
History Of

Pediatric patients with ventriculoperitoneal shunts commonly present with headaches. We report 7 children with ventriculoperitoneal shunts and occipital headaches who received occipital nerve blocks. Eighty-six percent of patients had a history of at least 1 ventriculoperitoneal shunt revision. Headaches improved in every patient after the block. Two patients (29%) were symptom free 11 and 12 months after the block. Four patients (57%) required repeat occipital nerve blocks. Two underwent pulsed radiofrequency ablation. No complications were noted. When patients with ventriculoperitoneal shunts present with headaches, a detailed physical examination is necessary. Persistent occipital headaches with tenderness and radiation in the path of the occipital nerves can be indicative of occipital neuralgia resulting from the shunt having crossed over the path of the greater or lesser occipital nerve. Occipital nerve blocks can help as both diagnostic and therapeutic interventions in these patients.

scholarly journals Nerves originating from brachial plexus in the porcupine (Hystrix cristata)

2012 ◽  
Vol 49 (No. 4) ◽  
pp. 123-128 ◽  
Author(s):  
A. Aydin
Keyword(s):  
Brachial Plexus ◽  
Biceps Brachii ◽  
Cranial Nerves ◽  
Suprascapular Nerve ◽  
Axillary Nerve ◽  
Biceps Brachii Muscle ◽  
Caudal Part ◽  
Hystrix Cristata ◽  
Dorsi Muscle ◽  
Thoracodorsal Nerve

In this study, dissemination of forelimb’s nerves of the porcupine (Hystrix cristata) was investigated. Four porcupines (two males and two females) were used and nerves originating from brachial their plexus were dissected. Origin and dissemination of forelimb’s nerves orginated from brachial plexus constituted from cranial and caudal trunks were examined. Suprascapular nerve and the first branch of subscapular nerve orginated from cranial and caudal part of cranial trunk, respectively. Nerves orginated from caudal trunk, pectoral cranial nerves, constituted four branches spreading in pectoral muscles. Musculocutenoeus nerve gives a branche to brachial muscle and, after giving medial cutaneus antebrachii nerve was divided to two branches (digital dorsal commun I and II nerve). Axillary nerve gives a branche to subscapular muscle and ends as cranial cutaneous antebrachii. Radial nerve separated to branches as ramus profundus and ramus superficial which also was divided to digital dorsal commun III and IV nerve and lateral cutaneus antebrachial nerve. Thoracodorsal nerve spreaded to latismus dorsi muscle. Median nerve was divided to digital dorsal commun I, II, III and IV nerve. Ulnar nerve was divided to digital dorsal commun V and digital dorsal commun V nerve after giving caudal cutaneous antebrachi. An undefined nerve branche orginated from caudal trunk entered corachobrachial muscle and biceps brachii muscle. Lateral thoracic and caudal pectoral nerves orginated from caudal trunk. In the porcupine, branche which goes to corachobrachial muscle directly from caudal trunk of the brachial plexus and distrubutions of musculocutaneous, radial, ulnar and median nerves were different from rodantia and other mammals.

Refining a great idea: the consolidation of PECS I, PECS II and serratus blocks into a single thoracic fascial plane block, the SAP block

2019 ◽  
pp. rapm-2019-100745 ◽  
Author(s):  
Carlo D Franco ◽  
Konstantin Inozemtsev
Keyword(s):  
Brachial Plexus ◽  
Chest Wall ◽  
Mechanism Of Action ◽  
Sensory Innervation ◽  
Common Mechanism ◽  
Nerve Blocks ◽  
Intercostal Nerves ◽  
Lateral Branches ◽  
Fascial Plane Block ◽  
Fascial Plane

The popularity of ultrasound-guided nerve blocks has impacted the practice of regional anesthesia in profound ways, improving some techniques and introducing new ones. Some of these new nerve blocks are based on the concept of fascial plane blocks, in which the local anesthetic is injected into a plane instead of around a specific nerve. Pectoralis muscles (PECS) and serratus blocks, most commonly used for post op analgesia after breast surgery, are good examples. Among the nerves targeted by PECS/serratus blocks are different branches of the brachial plexus that traditionally have been considered purely motor nerves. This unsubstantiated claim is a departure from accepted anatomical knowledge and challenges our understanding of the sensory innervation of the chest wall. The objective of this Daring Discourse is to look beyond the ability of PECS/serratus blocks to provide analgesia/anesthesia of the chest wall, to concentrate instead on understanding the mechanism of action of these blocks and, in the process, test the veracity of the claim. After a comprehensive review of the evidence we have concluded that (1) the traditional model of sensory innervation of the chest wall, which derives from the lateral branches of the upper intercostal nerves and does not include branches of the brachial plexus, is correct. (2) PECS/serratus blocks share the same mechanism of action, blocking the lateral branches of the upper intercostal nerves, and so their varied success is tied to their ability to reach them. This common mechanism agrees with the traditional innervation model. (3) A common mechanism of action supports the consolidation of PECS/serratus blocks into a single thoracic fascial plane block with a point of injection closer to the effector site. In a nod to transversus abdominus plane block, the original inspiration for PECS blocks, we propose naming this modified block, the serratus anterior plane block.

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