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

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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ESRA19-0336 Ultrasound-guided continuous costoclavicular brachial plexus block – a new approach for pain management in paediatrics physiotherapy

10.1136/rapm-2019-esraabs2019.326 ◽

2019 ◽

Author(s):

MB Bello Dias ◽

V Artilheiro ◽

R Regufe ◽

T Cenicante ◽

G Costa

Keyword(s):

Pain Management ◽

Brachial Plexus ◽

Brachial Plexus Block ◽

Ultrasound Guided ◽

New Approach ◽

Plexus Block

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Randomized comparison between perineural dexamethasone and dexmedetomidine for ultrasound-guided infraclavicular block

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-100680 ◽

2019 ◽

Vol 44 (10) ◽

pp. 911-916 ◽

Cited By ~ 1

Author(s):

Julián Aliste ◽

Sebastián Layera ◽

Daniela Bravo ◽

Diego Fernández ◽

Álvaro Jara ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Brachial Plexus ◽

Success Rate ◽

Motor Block ◽

Sensory Block ◽

Postanesthesia Care Unit ◽

Ultrasound Guided ◽

Blinded Observer ◽

Infraclavicular Block

BackgroundThis randomized trial compared perineural dexamethasone (5 mg) and dexmedetomidine (100 µg) for ultrasound-guided infraclavicular brachial plexus block. We hypothesized that both adjuvants would result in similar durations of motor block and therefore designed the study as an equivalence trial (equivalence margin=3.0 hours).MethodsOne hundred and twenty patients undergoing upper limb surgery with ultrasound-guided infraclavicular block (using 35 mL of lidocaine 1%–bupivacaine 0.25% with epinephrine 5 µg/mL) were randomly allocated to receive perineural dexamethasone (5 mg) or dexmedetomidine (100 µg). Patients and operators were blinded to the nature of the perineural adjuvant. After the performance of the block, a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 out of 16 points at 30 min) as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental blocks, intravenous opioids, or general anesthesia). Heart rate and blood pressure were recorded before the block as well as during the first 2 hours after its performance. Furthermore, the level of sedation (using the Ramsay Sedation Scale) was recorded in the postanesthesia care unit. Postoperatively, the blinded observer contacted patients with successful blocks to inquire about the duration of motor block, sensory block, and postoperative analgesia.ResultsNo intergroup differences were observed in terms of success rate and surgical anesthesia. Compared with dexmedetomidine, dexamethasone provided longer durations of motor block (17.4 (4.0) vs 14.3 (3.0) hours; p<0.001; 95% CI 1.7 to 4.5), sensory block (19.0 (4.0) vs 15.0 (3.2) hours; p<0.001; 95% CI 2.6 to 5.4), and analgesia (22.2 (3.6) vs 16.9 (3.9) hours; p<0.001; 95% CI 3.7 to 6.9). Dexmedetomidine resulted in lower heart rate and blood pressure after the performance of the block, as well as an increased level of sedation postoperatively.ConclusionCompared with dexmedetomidine (100 µg), dexamethasone (5 mg) results in longer sensorimotor block and analgesic durations, as well as a decreased level of patient sedation. Further studies are required to compare dexamethasone and dexmedetomidine using different doses, local anesthetic agents, and approaches to the brachial plexus.Trial registration numberNCT03610893

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Ultrasound-guided infraclavicular brachial plexus block: An alternative technique to anatomical landmark-guided approaches

Regional Anesthesia and Pain Medicine ◽

10.1053/rapm.2000.18184 ◽

2000 ◽

Vol 25 (6) ◽

pp. 600-604 ◽

Cited By ~ 28

Author(s):

C Ootaki

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Block ◽

Anatomical Landmark ◽

Alternative Technique ◽

Ultrasound Guided ◽

Infraclavicular Brachial Plexus Block ◽

Plexus Block

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Ultrasound Guided Axillary Brachial Plexus Block Versus Supraclavicular Block In Emergency Crushed Hand Patients : A Comparative Study

The Open Anesthesia Journal ◽

10.2174/2589645801812010034 ◽

2018 ◽

Vol 12 (1) ◽

pp. 34-41

Author(s):

Rania Maher Hussien ◽

Dalia Ahmed Ibrahim

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Block ◽

Onset Time ◽

Hand Surgery ◽

Good Alternative ◽

Ultrasound Guided ◽

Performance Time ◽

Needle Pass ◽

Supraclavicular Block ◽

Plexus Block

Background: The current study focusses on ultrasound guided Brachial Plexus Block (BPB) which plays an important role in patients with hand trauma either in pain control or for surgical intervention. The brachial plexus can be blocked by several techniques but the most commonly used are the Supraclavicular (SCB) and Axillary (AXB) blocks. Objective: To compare the two techniques with regards to the performance time, needling time, anesthesia-related time, block-related complications, number of needle pass and block related pain. Methods: After approval of the ethical committee and obtaining a written informed consent from patients, this prospective, randomized, interventional double-blinded study was done to patients undergoing emergency crushed hand surgery. 80 patients were allocated randomly into two equal groups. Under ultrasound guidance, the SCB and AXB were done for the two groups, respectively. The needling time, performance time, anesthesia-related time, onset time, number of 1st needle pass in each group and block related complications were noted. Statistical Analysis: Data were analysed using the Statistical Package for Social Science (IBM SPSS) version 23 SPSS. Results: Longer needling, performance, anesthesia-related time in the AXB group than SCB and less complications have occurred with AXB than SCB group. Conclusion: Axillary block of brachial plexus is a good alternative to Supraclavicular block in emergency crushed hand surgery and the choice is made according to the requirement of each case.

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A multicenter, randomized comparison between 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular block

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-000032 ◽

2019 ◽

Vol 44 (1) ◽

pp. 46-51 ◽

Cited By ~ 2

Author(s):

Daniela Bravo ◽

Julian Aliste ◽

Sebastián Layera ◽

Diego Fernández ◽

Prangmalee Leurcharusmee ◽

...

Keyword(s):

Brachial Plexus ◽

Motor Block ◽

Onset Time ◽

Sensory Block ◽

Procedural Pain ◽

Ultrasound Guided ◽

Performance Time ◽

Blinded Observer ◽

Infraclavicular Block ◽

Equivalence Margin

Background and objectivesThis multicenter, randomized trial compared 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular brachial plexus block. Our research hypothesis was that all three doses of dexamethasone would result in equivalent durations of motor block (equivalence margin=3.0 hours).MethodsThree hundred and sixty patients undergoing upper limb surgery with ultrasound-guided infraclavicular block were randomly allocated to receive 2, 5, or 8 mg of preservative-free perineural dexamethasone. The local anesthetic agent (35 mL of lidocaine 1%-bupivacaine 0.25% with epinephrine 5 µg/mL) was identical in all subjects. Patients and operators were blinded to the dose of dexamethasone. During the performance of the block, the performance time, number of needle passes, procedural pain, and complications (vascular puncture, paresthesia) were recorded. Subsequently a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 out of 16 points at 30 min), onset time as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental blocks, intravenous opioids, or general anesthesia). Postoperatively, the blinded observer contacted patients with successful blocks to inquire about the duration of motor block, sensory block, and postoperative analgesia. The main outcome variable was the duration of motor block.ResultsNo intergroup differences were observed in terms of technical execution (performance time/number of needle passes/procedural pain complications), onset time, success rate, and surgical anesthesia. Furthermore, all three doses of dexamethasone provided similar durations of motor block (14.9–16.1 hours) and sensory block. Although 5 mg provided a longer analgesic duration than 2 mg, the difference (2.7 hours) fell within our pre-established equivalence margin (3.0 hours).Conclusions2, 5, and 8 mg of dexamethasone provide clinically equivalent sensorimotor and analgesic durations for ultrasound-guided infraclavicular block. Further trials are required to compare low (ie, 2 mg) and ultra-low (eg, 0.5–1 mg) doses of perineural dexamethasone for brachial plexus blocks.Trial registration numberTCTR20150624001.

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