The Subclavian Perivascular Technique of Brachial Plexus Anesthesia

Winnie, Alon P.; Collins, Vincent J.

doi:10.1097/00000542-196405000-00014

Cited by 212 publications

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“…Using this technique results in the upper blockade of the brachial plexus. In 1921, Reding described anesthesia of the terminal branches of the brachial plexus in the lower part of axilla, which is currently performed [4]. Parasthesia appearance was a confirmation of the appropriate placement of needle in relation to nerve structures.…”

Section: Historical Overviewmentioning

confidence: 99%

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Blokada pachowa splotu ramiennego pod kontrolą ultrasonografii. Część 1 — podstawy anatomii ultrasonograficznej

Nowakowski¹,

Bieryło²

2015

Anaesthesiol Intensive Ther

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Axillary brachial plexus block is one of the most popular and widely used approaches for brachial plexus blocks. Its main advantages are its versatility and high safety. Brachial block facilitates analgesia for the distal arm, elbow, forearm and hand. Numerous upper limb procedures, particularly orthopedic ones, can be carried out under axillary block. Axillary block is well suited for the ultrasound-guided technique. Because the brachial plexus in the axillary region is located superficially, the nerves, block needle, and local anesthetic spread are all relatively easy to visualize. A high-frequency linear probe can be used during block procedure, so the quality and resolution of the ultrasound images are excellent. An important feature of the axillary approach is its high level of safety. In the axillary area, there are no anatomical structures other than vessels, to which damage during block placement could pose a risk for the patient. For this reason, axillary block is one of the techniques that are recommended for learning ultrasound-guided regional anesthesia. This paper summarizes anatomical fundamentals and provides basic sonoanatomic knowledge that is essential for successful ultrasound-guided axillary block.Key words: regional anesthesia, peripheral nerve block, brachial plexus; regional anesthesia, peripheral nerve block, axillary block; ultrasound, sonoanatomy Anaesthesiology Intensive Therapy 2015, vol. 47, no 4, 409-416 Axillary brachial plexus block is one of the most popular and widely used techniques for brachial plexus blocks [1]. This approach is very universal and safe, and it allows analgesia for the distal arm, elbow, forearm and hand. Numerous upper limb procedures, in particular orthopedic ones, could be carried out under axillary block. Axillary block is well suited for ultrasound-guided techniques. The brachial plexus in the axillary region is located superficially, so the nerves, block needle and local anesthetic spread are relatively easy to visualize. A high-frequency linear probe can be used during block procedure, so the quality and resolution of ultrasound image are excellent. This approach is also very safe because in the axillary area there are no anatomical structures other than vessels, which damage during block placement could put a patient at risk. For this reason, axillary block is one of the techniques that are recommended for physicians learning ultrasound-guided regional anesthesia [2]. This paper is the first part of a review of the axillary brachial plexus block that summarizes the anatomical fundamentals and basic sonoanatomic knowledge that are essential for successful ultrasound-guided axillary block. Part two presents the techniques and possibilities for performing the axillary brachial plexus block when using ultrasonography.

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Section: Historical Overviewmentioning

confidence: 99%

“…Alon Winnie supported the idea of a "volumetric" brachial plexus block. This method was a relatively simple way to achieve effective anesthesia by using a single anesthetic injection and popular [4,6].…”

Section: Historical Overviewmentioning

confidence: 99%

Blokada pachowa splotu ramiennego pod kontrolą ultrasonografii. Część 1 — podstawy anatomii ultrasonograficznej

Nowakowski¹,

Bieryło²

2015

Anaesthesiol Intensive Ther

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“…[13] oraz Winnie i wsp. [14] wykazali, że zdeponowanie w jednym punkcie dostatecznie dużej objętości ŚMZ, wystarczającej do wypełnienia pochewki splotu ramiennego wywołuje skuteczną blokadę. Popularyzacja wykorzystania stymulatorów nerwów i tym samym zwiększenie możliwości precyzyjnej lokalizacji pojedynczych nerwów umożliwiło zastosowanie techniki polegającej na podaniu anestetyku w kilku punktach, w sąsiedztwie poszczególnych znieczulanych struktur.…”

Section: Technika Podania I Objętość śRodka Znieczulającegounclassified

Zastosowanie ultrasonografii w anestezji regionalnej znacząco zmienia praktykę kliniczną blokad obwodowych

Nowakowski¹,

Bieryło²,

Duniec³

et al. 2014

Anaesthesiol Intensive Ther

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Background: Ultrasound-guided (US-guided) regional anaesthesia has gained worldwide popularity in recent years owing to the benefits the method offers to patients. The 1 st Department of Anaesthesiology and Intensive Care of Warsaw Medical University was one of the first centres in Poland to employ US-guided peripheral nerve blocks (PNB) on a routine basis. The technique was incorporated into the institution's clinical practice from 2007. The purpose of this study was to retrospectively assess changes in the clinical practice of US-guided versus non US-guided PNBs over six years of experience with the technique. Methods: Retrospective analysis assessing the prevalence of PNB methods, local anaesthetic (LA) injection techniques (i.e. single injection vs. multiple), LA volumes used, success rates and the incidence of complications. Results: This study included 4,066 PNBs performed between January 2006 and June 2012. The results showed systematic growth in the prevalence of US-guided blocks in the total number of PNBs, from 8.6% in 2007 up to 53.3% in 2012. The mean LA volume used in PNB was significantly lower in US-guided blocks compared to traditional PNB techniques (respectively, 21.83 mL vs. 31.41 mL, P < 0.05) without a decrease in the success rate (respectively, 76% vs. 74%, P > 0.05). A shift in the prevailing block technique from single injection to multiple injections was observed, regardless of the nerve location technique employed (from 29% up to 84% of PNBs performed using multiple injection technique). Conclusions: The use of ultrasound optimizes the technique of peripheral blocks and the amount of local anaesthetic used. Ultrasonography does not affect the safety of peripheral blocks.

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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%

“…Asking the patient to sniff through the nose helps identify the scalene muscles, which are muscles of inspiration. The external jugular vein is a useful landmark since it crosses the interscalene space at the C6 level in most individuals [15]. After the interscalene groove is identified, the two palpating fingers are pressed firmly into the groove (to minimize the distance from the skin the cervical intervertebral foramina) and are spread apart slightly.…”

Section: Anatomic Landmarksmentioning

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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The Subclavian Perivascular Technique of Brachial Plexus Anesthesia

Cited by 212 publications

References 0 publications

Blokada pachowa splotu ramiennego pod kontrolą ultrasonografii. Część 1 — podstawy anatomii ultrasonograficznej

Blokada pachowa splotu ramiennego pod kontrolą ultrasonografii. Część 1 — podstawy anatomii ultrasonograficznej

Zastosowanie ultrasonografii w anestezji regionalnej znacząco zmienia praktykę kliniczną blokad obwodowych

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

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