Ultrasonographic Findings of the Axillary Part of the Brachial Plexus

Retzl, Gerald; Kapral, Stephan; Greher, Manfred; Mauritz, W

doi:10.1097/00000539-200105000-00037

Cited by 192 publications

(88 citation statements)

References 9 publications

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“…Although ultrasound was used in both studies, local anesthetic placement was likely more accurate during a nerve targeted injection (in the present study) than a perivascular injection. In the ultrasonographic study by Retzl et al, 14 terminal branches of the brachial plexus were found in widely variable locations in the axillary region. The median nerve was most commonly found in sectors 7 and 8 (49%), the ulnar nerve in sectors 1-3 (91%) and the radial nerve in sectors 2 and 3 (58%).…”

Section: Discussionmentioning

confidence: 95%

Ultrasound guidance improves success rate of axillary brachial plexus block

Chan

Perlas

McCartney

et al. 2007

Can J Anesth/J Can Anesth

344

168

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Purpose: The purpose of this study is to determine if real time ultrasound guidance improves the success rate of axillary brachial plexus blockade. Methods:Patients undergoing elective hand surgery were randomly assigned to one of three groups. Axillary blocks were performed using three motor response endpoints in the nerve stimulator (NS) Group, real-time ultrasound guidance in the ultrasound (US) Group and combined ultrasound and nerve stimulation in the USNS Group. Following administration of a standardized solution containing 2% lidocaine with 1:200,000 epinephrine and 0.5% bupivacaine (total 42 mL), sensory and motor functions were assessed by a blinded observer every five minutes for 30 min. A successful block was defined as complete sensory loss in the median, radial and ulnar nerve distribution by 30 min. The need for local and general anesthesia supplementation and post-block adverse events were documented. Results:One hundred and eighty-eight patients completed the study. Block success rate was higher in Groups US and USNS (82.8% and 80.7%) than Group NS (62.9%) (P = 0.01 and 0.03 respectively). Fewer patients in Groups US and USNS required supplemental nerve blocks and/or general anesthesia. Postoperatively, axillary bruising and pain were reported more frequently in Group NS. Conclusion: This study demonstrates that ultrasound guidance, with or without concomitant nerve stimulation, significantly improves the success rate of axillary brachial plexus block. EG et EGNS (82,8 % et 80,7 %) que dans le groupe NS (62,9 %) (P = 0,01 et 0,03 respectivement Méthode : Des patients devant subir une chirurgie élective de la main ont été randomisés en trois groupes. Des blocs axillaires ont été effectués en utilisant : trois points de réponses motrices dans le groupe neurostimulateur (NS), l'échoguidage en temps réel dans le groupe échographie (EG), et l'échographie combinée à la stimulation nerveuse dans le troisième groupe (EGNS

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Section: Discussionmentioning

confidence: 95%

Ultrasound guidance improves success rate of axillary brachial plexus block

Chan

Perlas

McCartney

et al. 2007

Can J Anesth/J Can Anesth

344

168

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“…Ultrasound guidance allows not only for real-time, direct visualization of nerve structures, needle advancement, and local anesthetic spread, but also for detection of anatomic variations that are known to exist when compared to the anatomic dissections of cadavers illustrated in textbooks [7,8].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Imaging of the Sciatic Nerve Division in the Popliteal Fossa: A Volunteer Study

Chiang¹,

Dangerfield²,

Asay³

et al. 2013

OJAnes

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The Background and Objectives: A sciatic nerve block at the level of the popliteal fossa is frequently administered for post-operative analgesia for surgery below the knee. While ultrasound continues to gain popularity as the technique of choice for guiding needle positioning during peripheral nerve blocks, practitioners can begin to utilize ultrasound to look for patterns of anatomical significance. Recognizing anatomical variations among different demographic populations can help practitioners improve in performing nerve blocks. We aim to determine if predictable variability exists in sciatic nerve bifurcation location and depth at the level of the popliteal fossa. Methods: After IRB approval, eligible subjects were screened for ASA I or II status and demographic data was collected. Fifty subjects were enrolled. The SonoSite MicroMaxx ® with 38-mm broadband linear array, 13 -6 MHz probe with color Doppler and image capturing capabilities was used for ultrasound measurements. With subject lying prone, the location of the sciatic nerve in relation to the popliteal crease and skin-to-nerve distance were assessed via ultrasound. Two independent investigators confirmed nerve location for measurements. Analyses were performed with SAS version 9.1 using Pearson Correlation Coefficients and regression analysis. Results: Gender stratification revealed that, while males were both taller and heavier, skin-nerve measurements for depth were consistently deeper in females (p-value 0.02). Independent of the right or left leg, male gender and increased height decreases the skin-nerve distance, while increased weight increases the distance. There was no correlation between patient characteristics and crease-nerve distance. In some subjects, variability of crease-nerve distance even existed between their right and left leg. Conclusion: We show that significant variability exists for actual sciatic nerve bifurcation location, or target injection site, with consistently deeper skin depth values for female patients when compared to male patients, accounting for height and weight. These findings suggest visualization techniques such as ultrasound may lead to better localization of ideal injection sites.

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“…7 These characteristics should favor nerve identification and selective injection under ultrasound guidance. Nevertheless, Retzl et al showed that the nerves of the brachial plexus do not appear together on the same ultrasound screen 8 at the level of the humeral canal. Consequently, a blockade of these nerves with the classical single point of puncture is technically difficult.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided block of the brachial plexus at the humeral canal

Guntz

Broeck

Dereeper

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Conduction block of the brachial plexus block at the humeral canal, as described by Dupre, has certain clinical indications. The aim of this preliminary study was to assess the feasibility of this technique under ultrasound guidance. Methods After ultrasound evaluation of the brachial plexus at the humeral canal in 61 adult volunteers, we performed ultrasound-guided blocks in another 20 adult patients. A linear 38 mm probe, 13-6 MHz, and a 50-mm insulated block needle were used to guide injection of lidocaine 1.5% with epinephrine. Results Ulnar and median nerves are superficial and located at similar depths. Ultrasound imaging showed the musculocutaneous nerve to be located dorsally. The radial nerve is dorsal to the plane of the musculocutaneous nerve. Relative to the brachial artery, the median nerve is situated between 12 and 1 o'clock in 66% of the cases. Relative to the basilic vein, the ulnar nerve is situated at 3 o'clock in 46% of the cases. The evaluated block sequence was radial, ulnar, musculocutaneous and median nerve; two points of puncture were mandatory, and 6.85 ± 0.37 min were required to perform the blocks. Sensory onset times were similar for the four nerves. Injectate volume was lower for the musculocutaneous nerve compared to other nerves (P \ 0.05). All 20 patients experienced complete sensory and motor blocks. ConclusionWe describe an approach to, and the feasibility of ultrasound-guided block of the brachial plexus at the humeral canal. Further study will be required to establish the effectiveness and the safety of this technique. RésuméObjectif Les blocs de conduction du plexus brachial au niveau du canal hume´ral tels que de´crits par Dupre ont certaines indications cliniques. L'objectif de cette e´tude pre´liminaire e´tait d'e´valuer la faisabilite´de cette technique par e´choguidage. Méthode Apre`s une e´valuation ultrasonographique du plexus brachial au niveau du canal hume´ral chez 61 volontaires adultes sains, nous avons re´alise´des blocs par e´choguidage chez 20 autres patients adultes. Une sonde line´aire de 38 mm, 13-6 MHz, et une aiguille de bloc isole´e de 50 mm ont e´te´utilise´es pour guider l'injection de lidocaı¨ne 1,5% avec e´pine´phrine. Résultats Les nerfs cubital et me´dian sont superficiels et situe´s à des profondeurs similaires. L'imagerie par ultrason a montre´que le nerf musculocutane´e´tait situe´en position dorsale. Le nerf radial est dorsal au plan du nerf musculocutane´. Par rapport a`l'arte`re brachiale, le nerf me´dian se situe entre midi et une heure dans 66% des cas. Par rapport a`la veine basilique, le nerf cubital se situe a`3 heures dans 46% des cas. La se´quence de bloc e´value´e se situait au niveau des nerfs radial, cubital, musculocutaneé t me´dian; deux points de ponction e´taient requis, et 6,85 ± 0,37 min ont e´te´ne´cessaires pour re´aliser les blocs. Les de´lais d'action sensitifs e´taient semblables pour les 4 nerfs. Le volume de la dose injecte´e e´tait plus bas pour le nerf musculocutane´comparativement aux autres nerfs (P ...

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Ultrasonographic Findings of the Axillary Part of the Brachial Plexus

Cited by 192 publications

References 9 publications

Ultrasound guidance improves success rate of axillary brachial plexus block

Ultrasound guidance improves success rate of axillary brachial plexus block

Ultrasound Imaging of the Sciatic Nerve Division in the Popliteal Fossa: A Volunteer Study

Ultrasound-guided block of the brachial plexus at the humeral canal

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