Purpose: To ultrasonically identify the presence of septae within the neurovascular sheath and to assess their effect on local anesthetic spread when performing infraclavicular brachial plexus blocks.Clinical features: Thirty ASA status I and II patients scheduled for minor hand surgeries were enrolled in the study. Ultrasound guided infraclavicular brachial plexus blocks were performed on 28 patients. The images of the local anesthetic spread and the effect of the septum within the neurovascular sheath were analyzed. Septae were present in four of six patients where unilateral local anesthetic spread was seen. Septae were not visualized in the 22 patients with unrestricted local anesthetic spread after the initial injection. All 28 patients underwent their planned operations successfully with adequate anesthesia. Conclusions:Our study shows that the presence of septae within the neurovascular sheath may influence the pattern of local anesthetic spread associated with the infraclavicular approach to brachial plexus blocks. A previous cadaveric study revealed that a compartmentalized neurovascular sheath, and uneven distribution of local anesthetic around the nerve components of the plexus may be associated with failed and partial blocks. 1,2 With the use of nerve stimulators, the success rate of the single injection technique was as low as 44%, especially when only the lateral cord was stimulated. [3][4][5][6] We hypothesized that ultrasonographic identification of septae may be beneficial in performing infraclavicular brachial plexus blocks. The purpose of this study was to ultrasonically identify the presence of septae within the neurovascular sheath and to assess their possible effect on local anesthetic spread.

The use of ultrasound has gained popularity to perform peripheral nerve blocks. In this case report, a successful lumbar plexus block was performed with ultrasound guidance. By direct visualization, using this technology may potentially reduce complications associated with lumbar plexus blocks.

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