Ultrasound-guided central cluster approach for the supraclavicular brachial plexus block: a case series

Lee, Mi Geum; Lee, Kyung Cheon; Kim, Hong Soon; Park, Seol Ju; Suh, Young Je; Shin, Hyeon Ju

doi:10.4097/kjae.2015.68.6.603

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…Early papers of ultrasound guidance described the brachial plexus as a ‘cluster of hypoechoic nodules’ or as a main and other satellite ‘neural clusters’ [ 14 , 17 ]. During targeted intracluster injection, the needle is advanced within the sheath containing one or more clusters of hypoechoic neurologic elements, and the local anesthetic is injected inside the clusters [ 18 , 19 ]. The nerve structures were approached as a group, without distinguishing the identity and location of each individual trunk due to relatively low qualities of ultrasound imaging.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the ulnar nerve blockade between intertruncal and corner pocket approaches for supraclavicular block: a randomized controlled trial

Park

et al. 2021

Korean J Anesthesiol

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Background: The corner pocket (CP) approach for supraclavicular block (SCB) prevents ulnar nerve (UN) sparing due to needle proximity of lower trunk. Improved ultrasound resolution has suggested that the intertruncal (IT) approach is a suitable alternative method. However, the comparative efficiency of these two approaches on UN block has not been evaluated.Methods: Sixty patients were randomized to undergo SCB using the ultrasound-guided CP or IT approach. For lower trunk blockade, 10 mL of local anesthetic agents (1:1 mixture of 0.75% ropivacaine and 1% lidocaine) were injected in the CP (CP approach) or between the lower and middle trunk (IT approach). Additional 15mL was injected identically to block the middle and upper trunks in both groups. Sensory and motor blockade was evaluated after intervention. Results: Complete sensory blockade (75.9% [22/29] vs 43.3% [13/30], P = 0.023) and complete motor blockade (82.8% [24/29] vs 50.0% [15/30], P = 0.017) of the UN at 15 min after SCB were significantly more frequent in the IT than in the CP group. Sensory block onset time of UN was significantly shorter in the IT compared to the CP group (15.0 [10.0; 15.0] min vs 20.0 [15.0; 20.0] min; P = 0.011). Conclusions:The IT approach provided a more rapid onset of sensory and motor block of the UN than the CP approach. These results suggest that the IT approach is a suitable alternative to the CP approach and can provide faster surgical readiness.

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Section: Discussionmentioning

confidence: 99%

Comparison of the ulnar nerve blockade between intertruncal and corner pocket approaches for supraclavicular block: a randomized controlled trial

Park

et al. 2021

Korean J Anesthesiol

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“…However, the sensory-motor test evaluations were performed by an independent blinded observer. Therefore, we believe that unintentional bias had little impact on the overall results (12).…”

Section: Wwwpainphysicianjournalcommentioning

confidence: 94%

A Comparison of Anesthetic Quality Between Interscalene Block and Superior Trunk Block for Arthroscopic Shoulder Surgery: A Randomized Controlled Trial

et al. 2021

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Background: Interscalene block is the most commonly used nerve block for shoulder surgery, and superior trunk block has been investigated as a phrenic-sparing alternative. This randomized controlled trial compared ultrasound-guided interscalene block and superior trunk block as anesthesia for arthroscopic shoulder surgery. Objectives: Our aims were to determine the superiority of anesthesia quality and compare the risk of hemidiaphragmatic paralysis between these 2 blocks. Study Design: A randomized, controlled trial. Setting: Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital. Methods: Forty-eight patients undergoing elective arthroscopic shoulder surgery under an ultrasound guided brachial plexus block were randomized to receive either an interscalene block (ISB group, n = 24) or a superior trunk block (STB group, n = 24) for surgery. Ten milliliters of 2% lidocaine and 10 mL of 0.75% ropivacaine were used as local anesthesia in both brachial plexus block groups (total 20 mL). In the ISB group, the local anesthesia was injected between the C5–C6 root and at the upper part of C5 with equally divided doses. In the STB group, the local anesthesia was injected into the anterior and posterior parts of the superior trunk with equally divided doses. Sensory blockade of each trocar’s insulting site (supraclavicular, axillary, and suprascapular nerve areas) and motor blockade of the axillary nerve (shoulder abduction) and the suprascapular nerve (shoulder external rotation) were assessed by a blinded observer at 5-minute intervals for 30 minutes after the block. Anesthesia quality was assessed using 3 grades (excellent/insufficient/failure). The blinded investigator also assessed the grade of hemidiaphragmatic paralysis (normal/partial/complete) by comparing pre- and postoperative chest radiographs. Primary outcome variables were anesthesia grade and rate of hemidiaphragmatic paralysis. Secondary outcome variables were performance time and anesthesia onset time. Results: The anesthetic grade was significantly different between the 2 groups (22/2/0 in the ISB group vs. 16/3/5 in the STB group, P = 0.046). Both groups displayed equivalent incidence of hemidiaphragmatic paralysis (12/6/6 in the ISB group vs. 7/14/3 in the STB group, P = 0.063). No intergroup differences were found in terms of performance time and anesthesia onset time. Limitations: Our sensory and motor function test was not applied to the subscapular nerve, which serves internal rotation of the humeral head so may be difficult to evaluate in patients with rotator cuff tears. We assessed the diaphragmatic movement by chest radiographs instead of by ultrasound. Conclusions: The superior trunk block provided lower quality of surgical anesthesia than the interscalene block and did not effectively decrease the risk of hemidiaphragmatic paralysis during arthroscopic shoulder surgery for rotator cuff syndrome. Key words: Brachial plexus block, hemidiaphragmatic paralysis, interscalene block, superior trunk block, ultrasound

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“…Lee et al demonstrated in a series of 51 patients that single injection of LA into the central cluster of the supraclavicular brachial plexus was associated with a success rate of 92.2% (47 out of 51 patients needed no LA supplementation for hand and forearm surgery) [16] (Fig. 4).…”

Section: Upper Limb Brachial Plexus Blocksmentioning

confidence: 99%

Recent advances in regional anaesthesia

Chhabra

2016

Trends in Anaesthesia and Critical Care

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Ultrasound-guided central cluster approach for the supraclavicular brachial plexus block: a case series

Cited by 4 publications

References 15 publications

Comparison of the ulnar nerve blockade between intertruncal and corner pocket approaches for supraclavicular block: a randomized controlled trial

Comparison of the ulnar nerve blockade between intertruncal and corner pocket approaches for supraclavicular block: a randomized controlled trial

A Comparison of Anesthetic Quality Between Interscalene Block and Superior Trunk Block for Arthroscopic Shoulder Surgery: A Randomized Controlled Trial

Recent advances in regional anaesthesia

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