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A randomized comparative study of efficacy of axillary and infraclavicular approaches for brachial plexus block for upper limb surgery using peripheral nerve stimulator
Lahori Vikram,Raina Anjana,Gulati Smriti,Kumar Dinesh
Indian Journal of Anaesthesia , 2011,
Abstract: Brachial plexus block via the axillary approach is problematic in patients with limited arm mobility. In such cases, the infraclavicular approach may be a valuable alternative. The purpose of our study was to compare axillary and infraclavicular techniques for brachial plexus block in patients undergoing forearm and hand surgeries. After obtaining institutional approval and written informed consent, 60 patients of American Society of Anaesthesiologists grade I or II scheduled for forearm and hand surgeries were included in the study and were randomly allocated into two groups. Brachial plexus block was performed via the vertical infraclavicular approach (VIB) in patients of Group I and axillary approach in Group A using a peripheral nerve stimulator. Sensory block in the distribution of individual nerves supplying the arm, motor block, duration of sensory block, incidence of successful block and various complications were recorded. Successful block was achieved in 90% of the patients in group I and in 87% of patients in group A. Intercostobrachial nerve blockade was significantly higher in group I. No statistically significant difference was found in sensory and motor blockade of other nerves. Both the approaches are comparable, but the VIB scores ahead of axillary block in terms of its ability to block more nerves. The VIB because of its easily identifiable landmarks, a comfortable patient position during the block procedure and the ability to block a larger spectrum of nerves should thus be considered as an effective alternative to the axillary approach.
Anomalous patterns of formation and distribution of the brachial plexus in Nigerians and the implication for brachial plexus block
SS Adebisi, SP Singh
Nigerian Journal of Surgical Research , 2002,
Abstract: block Background: Structural variations in the patterns of formation and distribution of the brachial plexus have drawn attentions both in anatomy and anaesthesia. Method: An observational study. Results: The brachial plexus was carefully inspected in both the right and left arms in 90 Nigerian cadavers, comprising of 74 males and 16 females. Four anomalous patterns of formation and distribution of the plexus were observed in 65(72%) of the subjects. These include an additional 4th trunk formed by C5 in 20(22.2%) and the anticlockwise displacement of the cords with respect to the axillary artery in 12(13.3%) cases; such patterns had hitherto not been reported. Conclusion: These findings have important clinical implications for brachial plexus block.
The Existence of Axillary Arch in Human Fetus and Applied Importance and Clinical Implications in the Axillary Brachial Plexus Blocks
Orhan,Mustafa; Kervancioglu,Piraye; Cocelli,Lütfiye Pirbudak;
International Journal of Morphology , 2012, DOI: 10.4067/S0717-95022012000100049
Abstract: axillary arch is the most common muscle variation of axillary fossa that gains importance for regional interventional procedures, screening methods and physical examination. in order to avoid malpractice the variations must be borne in mind. this study has been planned to research the frequency and the features of the axillary arch in human fetus, to mention the potential clinical and functional significance of axillary arch while applying axillary brachial plexus block and reflect on possible complications. axillary fossa was examined with a stereomicroscope in 20 upper extremities of ten human fetuses. the gestation ages ranged from 16 to 36 weeks. axillary arch was determined in 2/20 specimen unilaterally. in both specimen, muscular slip detached from latissimus dorsi, passed anterior neurovascular bundle and ended posterior pectoralis major tendon and lateral border of intertubercular groove. in one specimen axillary arch was innervated with medial pectoral nerve whereas the other one did not have a particular innervating nerve branch. the possible effects of axillary arch in the axillary brachial plexus block applications are discussed. arcus axillaris may have a potential clinical and functional significance with regard the axillary brachial plexus block applications and may have possible effects on failure rate and acute complications. also, we think that this fetus study which the pure structure of the muscles without any usage effect can be observed will be beneficial regarding this topic.
Axillary brachial plexus blockade in moyamoya disease?  [cached]
Yalcin Saban,Cece Hasan,Nacar Halil,Karahan Mahmut
Indian Journal of Anaesthesia , 2011,
Abstract: Moyamoya disease is characterized by steno-occlusive changes of the intracranial internal carotid arteries. Cerebral blood flow and metabolism are strictly impaired. The goal in perioperative anaesthetic management is to preserve the stability between oxygen supply and demand in the brain. Peripheral nerve blockade allows excellent neurological status monitoring and maintains haemodynamic stability which is very important in this patient group. Herein, we present an axillary brachial plexus blockade in a moyamoya patient operated for radius fracture.
Clinically significant variations of the cords of the brachial plexus in relation to axillary artery
Jamuna M
International Journal of Anatomical Variations , 2011,
Abstract: Variations in the formation, course and distribution of brachial plexus are common and are well documented, but the variation of the cords of brachial plexus in relation to axillary artery is rarely documented. Here a rare variation of the cords of brachial plexus and the branches of the cords in relation to the axillary artery in the right upper limb of an adult male cadaver is reported. The lateral, medial and posterior cords were present lateral to the axillary artery and all the branches of the cords were also present lateral to the axillary artery. The musculocutaneous nerve was found not piercing the coracobrachialis muscle. The clinical significance and the embryological reasons are discussed. Clinicians and surgeons should be aware of such variations while performing surgical procedure in the axilla as the nerves are more prone for injury.
Non-Stimulation Needle with External Indwelling Cannula for Brachial Plexus Block and Pain Management in 62 Patients Undergoing Upper-Limb Surgery  [cached]
Bin Yu, Xiaoqing Zhang, Peili Sun, Shuqi Xie, Qiying Pang
International Journal of Medical Sciences , 2012,
Abstract: Objective: To investigate the feasibility of a non-stimulation needle with an external indwelling cannula for upper-limb surgery and acute postoperative pain management. Methods: 62 patients undergoing either scheduled or emergency upper-limb surgery received brachial plexus block of modified interscalene or axillary brachial and then postoperative patient-controlled analgesia (PCA) with local analgesics using a specially designed non-stimulation needle with an external indwelling cannula. The outcome measurements included anesthetic effect, acute or chronic complications, postoperative analgesic effect and patient's satisfaction. Results: The success rate of anesthesia was 96.8%. The single attempt placement with the external indwelling cannula was achieved in 85.2% of patients with axillary brachial plexus block and 78.8% with modified interscalene brachial plexus block. The incidence of severe intoxication was 3.7% with axillary brachial plexus block and 3.0% with modified interscalene brachial plexus block. No hematoma at the injection site, Horner's syndrome, hoarseness or dyspnea was observed. Postoperative analgesic effect was achieved in 100% and activities were slightly lowered in 91.7%. The incidence of nausea and vomit was 8.3%; patient's satisfaction was 9.1 on a 10-point scale system. Infection, nerve injury and respiratory depression were absent during the catheter indwelling. The indwelling time of external indwelling cannula was 30.5 h on average. There was no nerve injury related complication after withdrawing the external indwelling catheter. Conclusions: Brachial plexus block using a non-stimulation needle with an external indwelling cannula has favorable intra-operative anesthetic benefit and provides an excellent postoperative analgesic outcome. The low incidence of complications and favorable patient's satisfaction suggest that non-stimulation needle with an external indwelling cannula is a useful and safe anesthetic tool in brachial nerve block and acute postoperative pain management.
Ultrasound-guided brachial plexus block: a study on 30 patients
Amiri HR,Makarem J
Tehran University Medical Journal , 2009,
Abstract: "n Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Successful brachial plexus blocks rely on proper techniques of nerve localization, needle placement, and local anesthetic injection. Standard approaches used today (elicitation of paresthesia or nerve-stimulated muscle contraction), unfortunately, are all "blind" techniques resulting in procedure-related pain and complications. Ultrasound guidance for brachial plexus blocks can potentially improve success and complication rates. This study presents the ultrasound-guided brachial plexus blocks for the first time in Iran in adults and pediatrics. "n"n Methods: In this study ultrasound-guided brachial plexus blocks in 30 patients (25 adults & 5 pediatrics) scheduled for an elective upper extremity surgery, are introduced. Ultrasound imaging was used to identify the brachial plexus before the block, guide the block needle to reach target nerves, and visualize the pattern of local anesthetic spread. Needle position was further confirmed by nerve stimulation before injection. Besides basic variables, block approach, block time, postoperative analgesia duration (VAS<3 was considered as target pain control) opioid consumption during surgery, patient satisfaction and block related complications were reported."n"n Results: Mean adult age was 35.5±15 and in pediatric group was 5.2±4. Frequency of interscalene, supraclavicular, axillary approaches to brachial plexus in adults was 5, 7, 13 respectively. In pediatrics, only supraclavicular approach was accomplished. Mean postoperative analgesia time in adults was 8.5±4 and in pediatrics was 10.8±2. No block related complication were observed and no supplementary, were needed. "nConclusions: Real-time ultrasound imaging during brachial plexus blocks can facilitate nerve localization and needle placement and examine the pattern and extend of local anesthetic spread.
The comparisan of effects of ropivacaine and ropivacaine plus neastigmine in axillary brachial block procedure  [cached]
Beyaz?t Zencirci,Hafize ?ksüz,Kas?m Zafer Yüksel
Erciyes Medical Journal , 2007,
Abstract: Purpose: Axillary block can be achieved either with transarterial, paresthesia technique or via nerve stimulator usage. The aim of this study was to compare the effects of ropivacaine and ropivacaine plus neostigmine on post-operative analgesia and motor block, administered for axillary block with nerve-stimulator technique in neurosurgical patients scheduled to undergo operation for carpal tunnel syndrome.Material and Methods: 44 ASA (American Society of Anesthesiologists) II or I cases were randomly separated into two groups. Cases in the 1st group (Group RP) treated with 0.75% ropivacaine (40 ml) + 1 ml of NaCl 0.9% and 2nd (Group RN) with 0.75% ropivacaine (40 ml) + 1 ml (500 mcg) of neostigmine. Sensorial and motor block beginning time, degree and total block times were also observed.Results: There was no statistically significant difference between the groups regarding the beginning time and rate of complete sensory, motor block observed, and also sensory and motor block duration times.Conclusion: Neostigmine supplementation to ropivacaine for axillary block had no additional effect on sensory and motor block beginning time, duration and also quality. We conclude that ropivacaine has adequate effect on sensory and motor block for brachial plexus block procedure without the need for additional adjuvant neostigmine supplementation.
Combination of Interscalene Brachial and Superficial Cervical Plexus Block for Fracture Clavicle Surgery  [PDF]
Anirban Pal,Nidhi Dawar,Rajarsree Biswas,Chaitali Biswas
Indian Anaesthetists' Forum , 2011,
Abstract: We report a case of interscalene brachial plexus block supplemented with superficial cervical plexus block in a patient with dilated cardiomyopathy with ejection fraction of 24% scheduled for surgery of fracture mid-shaft of clavicle.
Comparison Of Infraclavicular Brachial Plexus Block With Supraclavicular Brachial Plexus Block In Upper Limb Surgeries. (A Study Of 100 Patients)
Sheetal Shah,kamla Mehta,Kirti Patel,Khyati Patel
NHL Journal of Medical Sciences , 2013,
Abstract: Comparative prospective study of two routes of Brachial plexus block – infraclavicular coracoid approach with conventional supraclavicular approach was carried out in 100 patients of ASA RISK I to III, undergoing elective or emergency surgeries on upper limb, at the level of elbow and below elbow. Patients were divided into 2 equal groups, Group I (Infraclavicular) and Group S (Supraclavicular), which were compared for block performance time, onset, quality and duration of block. The applied anatomy, methodology, complications and limitations have been emphasized. The study concludes that infraclavicular brachial plexus block with coracoid approach is a useful block without complications if practiced with precautions.
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