Use of Magnetic Resonance Imaging to Define the Anatomical Location Closest to All Three Cords of the Infraclavicular Brachial Plexus

Abstract

Infraclavicular techniques are often used to perform brachial plexus blocks. In our volunteer study we used magnetic resonance imaging to identify the brachial plexus and axillary vessels in a sagittal plane corresponding to the lateral sagittal infraclavicular block. In 20 volunteers, all cords were positioned within 2 cm from the artery approximately within 2/3 of a circle. We derived an injection site that was closest to all cords, cranio-posterior and adjacent to the axillary artery. We conclude that this knowledge may be useful for the performance of infraclavicular blocks aided by ultrasound. However, our proposals should be tested by clinical studies.

Ultrasound-guided regional anesthesia for upper limb surgery

“…6b). 28 Several clinical studies have confirmed this hypothesis. 20,29 A fascial click is felt just before reaching the posterior aspect of the artery and signals that the needle tip is in the right location.…”

“…6a). Une étude en résonnance magnétique a évalué qu'un seul point d'injection, situé en postérieur de l'artère axillaire pourrait permettre une diffusion de l'anesthésique local à tous les fascicules 28 (Fig. 6b).…”

Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks

“…The brachial plexus cords were typically seen in a circumferential manner within the neurovascular sheath at medial, lateral, and posterior locations around the artery. 9 After local anesthetic infiltration to the skin at a cranial location, a block needle (22G 30° short bevel 80 mm Chiba type needle, Havel's Inc., Cincinnati, OH, USA) was introduced along the long axis of the ultrasound probe at a 45° angle. Upon the needle tip reaching the lateral aspect of the neurovascular sheath, a dose of approximately 10 mL of local anesthetic was injected slowly under direct visualization.…”

Triple-Blind Randomized Clinical Trial of Time Until Sensory Change Using 1.5% Mepivacaine With Epinephrine, 0.5% Bupivacaine, or an Equal Mixture of Both for Infraclavicular Block

“…If any cord was not stimulated, LA was delivered in the zone (using ultrasound) where that cord presumably resides based on operator experience and a previously described magnetic resonance imaging study. 9 Peripheral nerve block procedure duration was calculated from time of block needle insertion until needle withdrawal. This was to assess if LA dwell times were similar among all 3 groups.…”