Functional Anatomy of the Brachial Plexus Sheaths

Thompson, Gale E.; Rorie, Duane K.

doi:10.1097/00000542-198308000-00009

Cited by 261 publications

(93 citation statements)

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“…In the infraclavicular region, the plexus sheath often becomes more loosely organized, and the con- nective tissue often extends inward, forming longitudinal septae between the cords. 1 The lateral aspect of the brachial plexus was chosen as the initial injection site for two reasons. First, because the ultrasound guided block needle was introduced from a cephalad location and directed inferiorly to the neurovascular bundle, the approach to the lateral cord was shorter and more direct when compared to the approach involving the posterior and medial aspects.…”

Section: Discussionmentioning

confidence: 99%

“…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: 99%

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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show abstract

“…6 Theoretically, if a local anesthetic is injected into the neurovascular sheath surrounding the brachial plexus, its distribution may block the nerves of the brachial plexus but the actual effects may vary. [7][8][9] Horner's Syndrome may occur even with the interception of the sympathetic nervous pathway from the hypothalamus to the eyeball. That is, the presence of Horner's Syndrome can be confirmed by checking the sympathetic nerve for damage by cocaine instillation.…”

Section: Discussionmentioning

confidence: 99%

Unilateral Horner's Syndrome following supraclavicular brachial plexus block

2018

KMJ

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Supraclavicular brachial plexus block, due to its wide range of indications, is the most widely practiced procedure in anesthesiology. We experienced the case of a 45-year-old female patient who developed unilateral Horner's Syndrome after the use of supraclavicular brachial plexus block. The patient recovered spontaneously from the Horner's syndrome after 2 hours. If Horner's syndrome should occur, its etiology will need to be assessed. It is also important to assure the patient they will recover from the complication within a year.

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“…Anatomical studies show the neurovascular space to be divided by multiple septae (9). This is the main reason for incomplete AXB.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Nerve Stimulator and Ultrasonography Application for Brachial Plexus Anesthesia

Zencirci¹,

Öksüz²

2012

Balkan Med J

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Objective: Axillary brachial plexus block can be achieved through various techniques in upper extremity operations. The purpose of our study was to compare the efficacy of axillary brachial plexus block using an ultrasound technique with peripheral nerve stimulation technique. Material and Methods:Sixty patients for whom elective forearm and hand surgery was planned were included in the study. Group 1 (n=30) was given an axillary block by using ultrasonography, Group 2 (n=30) was given axillary block by using a peripheral nerve stimulator. The quality and time of onset of the sensorial and motor blockade were assessed. Results:The average time needed to perform the axillary brachial plexus block was similar in both groups. Although not significant statistically, it was observed that the sensory block was achieved earlier in Group 1. However, the degree of motor blockade was more intense in Group 1 than in Group 2. Conclusion:The ultrasound-guided axillary brachial plexus block is a preferable method with faster onset time and better quality of motor blockade compared to the PNS technique.

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Functional Anatomy of the Brachial Plexus Sheaths

Cited by 261 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

Unilateral Horner's Syndrome following supraclavicular brachial plexus block

Comparison of Nerve Stimulator and Ultrasonography Application for Brachial Plexus Anesthesia

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Functional Anatomy of the Brachial Plexus Sheaths

Cited by 261 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

Unilateral Horner&apos;s Syndrome following supraclavicular brachial plexus block

Comparison of Nerve Stimulator and Ultrasonography Application for Brachial Plexus Anesthesia

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Unilateral Horner's Syndrome following supraclavicular brachial plexus block