Functional Anatomy of the Brachial Plexus Sheath

Partridge, Brian L.; Katz, Jordan; Benirschke, Kurt

doi:10.1097/00000542-198706000-00006

Cited by 199 publications

(69 citation statements)

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“…We can only hypothesize that the presence of septae resulted in incomplete blocks. Interestingly, if the infraclavicular brachial plexus anatomy is similar to that of the axillary region as described by Partridge et al, 2 there should be unrestricted fluid movement between the compartments. Although this does not fully support the observed lower success rates with single injection techniques, further study is warranted to examine the outcome of unilateral local anesthetic spread.…”

Section: Discussionmentioning

confidence: 88%

“…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.…”

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confidence: 99%

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Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks

Morimoto

Popović

Kim

et al. 2007

Can J Anesth/J Can Anesth

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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.

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Section: Discussionmentioning

confidence: 88%

mentioning

confidence: 99%

Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks

Morimoto

Popović

Kim

et al. 2007

Can J Anesth/J Can Anesth

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“…Dan J. Kopacz et al; concluded that onset time was reduced and the duration of analgesia increased on addition of dexamethasone [21].…”

Section: Onset Of Motor and Sensory Blockmentioning

confidence: 99%

Comparison of Tramadol and Dexamethasone as an adjuvant to Bupivacaine in Supraclavicular brachial plexus block: A Randomised Comparative Study in Patients undergoing Elective Upper limb surgeries

Yadav¹,

Saini²

2016

SJAMS

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Supraclavicular nerve block is good alternative to general anesthesia for upper limb surgery. This avoids the untoward effects of general anesthetic drugs and upper airway instrumentation. It achieves complete muscle relaxation, intraoperative hemodynamic stability, and postoperative analgesia. The objective is to compare the postoperative analgesia following supraclavicular brachial plexus block with Tramadol or Dexamethasone as an adjuvant to bupivacaine in elective upper extremity surgery. Total 60 patients of ASA I and II undergoing upper extremity surgery under brachial plexus block with Bupivacaine were randomly divided in to two groups; group A received Tramadol (2mg/kg) and group B received Dexamethasone (0.15mg/kg) as an adjuvant to Bupivacaine. The duration of postoperative analgesia was recorded in both groups using pain VAS score which was determined by maximum VAS score of 8-10 and when patient demands for additional analgesics. The mean duration of postoperative analgesia in the Dexamethasone group was 1023.87 ±161.01 minutes while in the tramadol group it was 454.47±44.29 minutes. Dexamethasone with local anaesthetic prolongs postoperative analgesia significantly than Tramadol (P<0.05) when used as admixture to local anaesthetic in brachial plexus block in upper extremity surgery.

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“…Perhaps the regional technique most widely practiced for shoulder surgery is the interscalene approach to the brachial plexus (interscalene block) [8,[14][15][16][17][18][19][20][21][22].…”

Section: Interscalene Brachial Plexus Blockmentioning

confidence: 99%

Anesthesia for Shoulder Surgery: A Review of the Interscalene Block and a Discussion of Regional vs. General Anesthesia

Ghaleb¹,

Dilley²

2012

TOATJ

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A review of the literature regarding anesthesia for shoulder surgery was performed. Current anesthetic techniques available include regional, general, or a combination of regional and general. We discuss each of these techniques, with an emphasis on regional (specifically interscalene block), in detail. Current evidence supports both regional and general anesthesia to be safe and efficient techniques. The interscalene block is considered by most to provide the best surgical anesthesia and is the most commonly performed block for shoulder surgery. This paper aims to review the performance of the interscalene block and to discuss alternative choices for shoulder surgery, namely general anesthesia and a combined general/regional technique. We also aim to provide considerations to aid in the performance of a safely administered anesthetic.

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Functional Anatomy of the Brachial Plexus Sheath

Cited by 199 publications

References 0 publications

Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks

Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks

Comparison of Tramadol and Dexamethasone as an adjuvant to Bupivacaine in Supraclavicular brachial plexus block: A Randomised Comparative Study in Patients undergoing Elective Upper limb surgeries

Anesthesia for Shoulder Surgery: A Review of the Interscalene Block and a Discussion of Regional vs. General Anesthesia

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