scholarly journals Risk Analysis of Needle Injury to the Long Thoracic Nerve during Ultrasound-Guided C7 Selective Nerve Root Block

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 635
Author(s):  
Seok Kang ◽  
Ha-Mok Jeong ◽  
Beom-Suk Kim ◽  
Joon-Shik Yoon
Keyword(s):  
Nerve Root ◽  
Injury Risk ◽  
Ultrasound Image ◽  
Radicular Pain ◽  
University Hospital ◽  
Cross Sectional ◽  
Long Thoracic Nerve ◽  
Nerve Root Block ◽  
Thoracic Nerve ◽  
Selective Nerve Root Block

Background and Objectives: Ultrasound (US)-guided cervical selective nerve root block (SNRB) is a widely used treatment for upper limb radicular pain. The long thoracic nerve (LTN) passes through the middle scalene muscle (MSM) at the C7 level. The needle trajectory of US-guided C7 SNRB pierces the MSM, therefore indicating a high probability of injury to the LTN. We aimed to identify the LTN and to investigate the risk of needle injury to the nerve during US-guided C7 SNRB. Materials and Methods: This retrospective observational study included 30 patients who underwent US-guided SNRB at the C7 level in a university hospital. We measured the maximal cross-sectional diameter (MCSD) of the LTN and cross-sectional area (CSA) of the C7 nerve root and assessed the injury risk of LTN during US-guided C7 SNRB by simulating the trajectory of the needle in the ultrasound image. Results: The LTN was detectable in all the cases, located inside and outside the MSM in 19 (63.3%) and 11 (36.7%) of cases, respectively. The LTN’s mean MCSD was 2.10 mm (SD 0.13), and the C7 root’s CSA was 10.78 mm2 (SD 1.05). The LTN location was within the simulated risk zone in 86.7% (26/30) of cases. Conclusion: Our findings suggest a high potential for LTN injury during US-guided C7 SNRB. The clear visualization of LTNs in the US images implies that US guidance may help avoid nerve damage and make the procedure safer. When performing US-guided C7 SNRB, physicians should take into consideration the location of the LTN.

Thoracic Epidural and Nerve Root Injections: Fluoroscopy

2016 ◽  
Author(s):  
Jianguo Cheng
Keyword(s):  
Nerve Root ◽  
Small Volume ◽  
Epidural Block ◽  
Nerve Roots ◽  
Nerve Root Block ◽  
Thoracic Epidural ◽  
Thoracic Nerve ◽  
Transforaminal Approach ◽  
Nerve Root Blocks ◽  
Selective Nerve Root Block

Thoracic nerve root blocks can be achieved by interlaminal epidural, transforaminal epidural, paravertebral, and selective nerve root injections. The interlaminal approach allows blocking multiple nerve roots bilaterally, while the transforaminal approach has the advantage of depositing the injectate primarily to the anterior epidural space on the side of the injection, closer to the pathology. The paravertebral approach is often used to block multiple nerve roots on the side of injection, and the selective nerve root block is used to target a specific nerve root using a small volume of injectate. Fluoroscopy-guided injection the most commonly used technique. Contrast materials are often used to confirm the appropriate needle placement and monitor the spread of the injectate. Thoracic nerve root block and transforaminal epidural block are perceived as technically demanding due to anatomic complexity of the thoracic spine, its proximity to the lungs and major vasculature, and potential complications.

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