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The Need for Supplemental Blocks in Infraclavicular Brachial Plexus Blocks

2019-09-30 07:07:10 | BioPortfolio

Summary

Theoretically all surgeries below mid-humerus can be done under infraclavicular (IC) blocks. Following the introduction of ultrasonography (USG) to the clinical anesthesia, plexus and nerve blocks under the guidance of USG have gained wide acceptance for the high rates of block success, and low risk of complications (1). In this study, we aimed to evaluate the single injection and triple injection techniques in IC blocks with USG-guided medial approach, in terms of block success and the need for supplementary blocks. Our secondary goals are to compare the complication rates, sensory block durations, and to discuss the possible reasons for the failure of the blocks.

Description

Theoretically all surgeries below mid-humerus can be done under infraclavicular (IC) blocks. Following the introduction of ultrasonography (USG) to the clinical anesthesia, plexus and nerve blocks under the guidance of USG have gained wide acceptance for the high rates of block success, and low risk of complications. At the same time, it was also shown that USG-guided IC blocks can shorten procedural times and accelerate the onset of the blocks.

Several methods for IC blocks have been described. Based on the anatomical knowledge, we hypothesized that in medial approaches the need for supplementary blocks would be low with single injections as well as triple injections. In this study, we aimed to evaluate the single injection and triple injection techniques in IC blocks with USG-guided medial approach, in terms of block success and the need for supplementary blocks. Our secondary goals are to compare the complication rates, sensory block durations, and to discuss the possible reasons for the failure of the blocks.

Medical records of 139 patients scheduled for elective or emergent hand, wrist, forearm, elbow, and distal arm surgery were analyzed. Patients older than 14-years with ASA physical status I-III, who underwent surgery between October 2017 and March 2019 were retrospectively evaluated. Exclusion criteria included non-cooperative patients, refusal of the regional anesthesia, known neuropathy that could prevent the evaluation of the efficacy of the block, different technique used for infraclavicular brachial plexus blocks (lateral sagittal, coracoid, …etc.), and known allergy to local anesthetic drugs.

Study Design

Conditions

Anesthesia, Regional

Intervention

Medial approach infraclavicular block with single injection, Medial approach infraclavicular block with triple injection

Location

Derince Training and Research Hospital
Kocaeli
Derince
Turkey
41900

Status

Completed

Source

Derince Training and Research Hospital

Results (where available)

View Results

Links

Published on BioPortfolio: 2019-09-30T07:07:10-0400

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Medical and Biotech [MESH] Definitions

The ligament that travels from the medial epicondyle of the FEMUR to the medial margin and medial surface of the TIBIA. The medial meniscus is attached to its deep surface.

A portion of the nucleus of ansa lenticularis located medial to the posterior limb of the internal capsule, along the course of the ansa lenticularis and the inferior thalamic peduncle or as a separate nucleus within the internal capsule adjacent to the medial GLOBUS PALLIDUS (NeuroNames, http://rprcsgi.rprc. washington.edu/neuronames/ (September 28, 1998)). In non-primates, the entopeduncular nucleus is analogous to both the medial globus pallidus and the entopeduncular nucleus of human.

A transitional diencephalic zone of the thalamus consisting of complex and varied cells lying caudal to the ventral posterolateral nucleus, medial to the rostal part of the pulvinar, and dorsal to the medial geniculate body. It contains the limitans, posterior, suprageniculate, and submedial nuclei.

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This area is bounded medially by the mammillothalamic tract and the anterior column of fornix. The medial edge of the internal capsule and the subthalamic region form its lateral boundary. It contains the lateral hypothalamic nucleus, tuberomammillary nucleus, lateral tuberal nuclei, and fibers of the MEDIAL FOREBRAIN BUNDLE. (Parent, Carpenter's Human Neuroanatomy, 9th ed, p710)

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