Quantitative Architecture of the Brachial Plexus and Surrounding Compartments, and Their Possible Significance for Plexus Blocks

Moayeri, Nizar; Bigeleisen, Paul E.; Groen, Gerbrand J.

doi:10.1097/01.anes.0000299433.25179.70

Cited by 133 publications

(106 citation statements)

References 17 publications

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“…Cadaver studies indicate that the amount of connective tissue within the epineurium of the brachial plexus is least at proximal sites (55% for interscalene and 52% for supraclavicular) compared with distal sites (66% for subcoracoid) [3]. However, even at proximal brachial plexus block sites, the majority of the intraneural space typically consists of connective tissue.…”

Section: ó 2011 the Authorsmentioning

confidence: 99%

Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound‐guided interscalene and supraclavicular nerve blocks*

Liu

YaDeau

Shaw³

et al. 2011

Anaesthesia

140

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SummaryIt is proposed that ultrasound guidance decreases the risk of intraneural injection and associated postoperative neurological complications. However, the incidence of unintentional intraneural injection with ultrasound is unknown. Two hundred and fifty-seven patients were enrolled in a prospective, single-blind observational study. All patients underwent a pre-operative neurological examination before ambulatory shoulder arthroscopy with sedation and ultrasound-guided interscalene or supraclavicular block. Patients were followed up at 1 week and at 4-6 weeks postoperatively. Two blinded anaesthesiologists viewed the same video of the ultrasound image during the block offline to determine intraneural trespass. Intraneural injection occurred in 42 patients (17%; 95% CI 12-22%). No patient suffered from postoperative neurological complications (0%; 95% CI 0-1.6%) at follow-up.

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Section: ó 2011 the Authorsmentioning

confidence: 99%

Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound‐guided interscalene and supraclavicular nerve blocks*

Liu

YaDeau

Shaw³

et al. 2011

Anaesthesia

140

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“…When nerves are impaled, the needle may pass harmlessly into or through connective tissue, which constitutes up to 70% of a nerve's cross-sectional area. 28 However, if the fascicle is penetrated, neurons are exposed to local anesthetics that can cause time-and concentration-dependent injury. Vasoconstrictors play a role by limiting local anesthetic clearance and thereby enhancing the time-dependent component of injury.…”

Section: Pathophysiology Of Peripheral Nerve Injurymentioning

confidence: 99%

ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

Neal¹,

Bernards²,

Hadžić³

et al. 2008

Regional Anesthesia and Pain Medicine

238

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Neurologic complications associated with regional anesthesia and pain medicine practice are extremely rare. The ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine addresses the etiology, differential diagnosis, prevention, and treatment of these complications. This Advisory does not focus on hemorrhagic and infectious complications, because they have been addressed by other recent ASRA Practice Advisories. The current Practice Advisory offers recommendations to aid in the understanding and potential limitation of neurologic complications that may arise during the practice of regional anesthesia and pain medicine. KeywordsComplications of anesthesia; Nerve injury; Spinal anesthesia; Epidural anesthesia; Peripheral nerve block; Regional anesthesia; Pain medicine; Transforaminal block The American Society of Regional Anesthesia and Pain Medicine (ASRA) convened a group of experts to develop a Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine. The goal of this Practice Advisory is to provide information for practitioners of regional anesthesia and pain medicine regarding the etiology, differential diagnosis, prevention, and treatment of neurologic complications. This Practice Advisory focuses on neurologic injuries apart from those caused by hemorrhagic 1 or infectious2 -6 complications, both of which have been the subject of other recent ASRA-sponsored Practice Advisories. The current report is a summation of the Practice Advisory's findings and recommendations. Anesthesiologists are strongly encouraged to read the manuscripts that accompany the present summary document, because they contain the details upon which recommendations are based. The accompanying manuscripts represent most of the subtopics discussed at the conference. The recommendations contained within this Practice Advisory represent the opinions of a small group of expert panelists and are based upon their clinical experience, review of limited scientific literature (anatomic and physiologic studies of animals and human cadavers, case reports, retrospective case series, and non-randomized trials), and open forum discussion. Importantly, in this imperfect setting of controversial topics, limited data, and bias inherent to expert opinion, the Panel consistently tended towards making conservative recommendations. We acknowledge that other experts analyzing the same information may arrive at recommendations different than ours. The recommendations contained herein are not intended to define standard practice or to ensure the avoidance of adverse outcomes. Furthermore, the recommendations are subject to change as new information becomes available. Recommendations from the Practice Advisory are not intended to replace clinical judgment, and specific risk-to-benefit discussions as they pertain to individual patients.Because neurologic injuries related to anesthesia and pain medicine practice are extremely rare, standard tools of evidence-based medicine such as randomized c...

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“…This explains why a simple penetration of the suprascapular nerve epineurium does not necessarily lead to nerve damage. 37,38 Local anesthetic infusion in the perineurium is associated with high injection pressure, subsequent fascicular lesion and neurologic injury, but the infusion within the epineurium occurs at low pressure, with motor function returning to normal. 39 Therefore, intraneural infusion outside the perineurium does not invariably lead to neurological damage.…”

Section: Peripheral Nerve Injurymentioning

confidence: 99%

Bloqueio do nervo supraescapular: procedimento importante na prática clínica. Parte II

Fernandes¹,

Barbosa²,

Sousa³

et al. 2012

Rev. Bras. Reumatol.

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The suprascapular nerve block is a reproducible, reliable, and extremely effective treatment method in shoulder pain control. This method has been widely used by professionals in clinical practice such as rheumatologists, orthopedists, neurologists, and pain specialists in the treatment of chronic diseases such as irreparable rotator cuff injury, rheumatoid arthritis, stroke sequelae, and adhesive capsulitis, which justifi es the present review (Part II). The objective of this study was to describe the techniques and complications of the procedure described in the literature, as the fi rst part reported the clinical indications, drugs, and volumes used in single or multiple procedures. We present in details the accesses used in the procedure: direct and indirect, anterior and posterior, lateral and medial, upper and lower. There are several options to perform suprascapular nerve block. Although rare, complications can occur. When properly indicated, this method should be considered.

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Quantitative Architecture of the Brachial Plexus and Surrounding Compartments, and Their Possible Significance for Plexus Blocks

Cited by 133 publications

References 17 publications

Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound‐guided interscalene and supraclavicular nerve blocks*

Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound‐guided interscalene and supraclavicular nerve blocks*

ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine

Bloqueio do nervo supraescapular: procedimento importante na prática clínica. Parte II

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