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Ultrasound-Guided Costoclavicular Brachial Plexus Block: Sonoanatomy, Technique, and Block Dynamics.
Reg Anesth Pain Med. 2017 Mar/Apr; 42(2):233-240.RA

Abstract

BACKGROUND AND OBJECTIVES

This study aimed to describe in detail the relevant sonoanatomy, technique, and block dynamics of an ultrasound-guided costoclavicular brachial plexus block (BPB).

METHODS

Thirty patients scheduled for hand or forearm surgery under a BPB underwent transverse ultrasound imaging of the medial infraclavicular fossa to identify the cords of the brachial plexus at the costoclavicular space (CCS). An ultrasound-guided BPB was then performed at the CCS with 20 mL of 0.5% ropivacaine. Sensory-motor blockade of the ipsilateral median, radial, ulnar, and musculocutaneous nerves were assessed at regular intervals for 30 minutes after the injection. Successful block was defined as being able to complete surgery under the BPB.

RESULTS

The CCS was visualized as a well-defined intermuscular space lying deep and posterior to the mid-point of the clavicle. The cords of the brachial plexus were clustered together lateral to the axillary artery within the CCS. The costoclavicular BPB was successfully performed in all patients, and the median onset time for sensory and motor blockade of all the 4 nerves was 5 [5-15] and 5 [5-10] minutes, respectively. Complete sensory blockade of all the 4 nerves was achieved in 30 [20-30] minutes, and the BPB was successful in 29 (97%) of 30 patients. There were no complications directly related to the technique or the local anesthetic injection.

CONCLUSIONS

This report describes a novel technique of infraclavicular BPB at the costoclavicular space that produces rapid onset of BPB. Future research should compare the safety and efficacy of this new technique with the traditional lateral sagittal infraclavicular BPB.

Authors+Show Affiliations

From the *Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; †Department of Anesthesiology, Hospital Clinic Barcelona; ‡and Department of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28157792

Citation

Li, Jia Wei, et al. "Ultrasound-Guided Costoclavicular Brachial Plexus Block: Sonoanatomy, Technique, and Block Dynamics." Regional Anesthesia and Pain Medicine, vol. 42, no. 2, 2017, pp. 233-240.
Li JW, Songthamwat B, Samy W, et al. Ultrasound-Guided Costoclavicular Brachial Plexus Block: Sonoanatomy, Technique, and Block Dynamics. Reg Anesth Pain Med. 2017;42(2):233-240.
Li, J. W., Songthamwat, B., Samy, W., Sala-Blanch, X., & Karmakar, M. K. (2017). Ultrasound-Guided Costoclavicular Brachial Plexus Block: Sonoanatomy, Technique, and Block Dynamics. Regional Anesthesia and Pain Medicine, 42(2), 233-240. https://doi.org/10.1097/AAP.0000000000000566
Li JW, et al. Ultrasound-Guided Costoclavicular Brachial Plexus Block: Sonoanatomy, Technique, and Block Dynamics. Reg Anesth Pain Med. 2017 Mar/Apr;42(2):233-240. PubMed PMID: 28157792.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultrasound-Guided Costoclavicular Brachial Plexus Block: Sonoanatomy, Technique, and Block Dynamics. AU - Li,Jia Wei, AU - Songthamwat,Banchobporn, AU - Samy,Winnie, AU - Sala-Blanch,Xavier, AU - Karmakar,Manoj Kumar, PY - 2017/2/6/pubmed PY - 2018/9/18/medline PY - 2017/2/4/entrez SP - 233 EP - 240 JF - Regional anesthesia and pain medicine JO - Reg Anesth Pain Med VL - 42 IS - 2 N2 - BACKGROUND AND OBJECTIVES: This study aimed to describe in detail the relevant sonoanatomy, technique, and block dynamics of an ultrasound-guided costoclavicular brachial plexus block (BPB). METHODS: Thirty patients scheduled for hand or forearm surgery under a BPB underwent transverse ultrasound imaging of the medial infraclavicular fossa to identify the cords of the brachial plexus at the costoclavicular space (CCS). An ultrasound-guided BPB was then performed at the CCS with 20 mL of 0.5% ropivacaine. Sensory-motor blockade of the ipsilateral median, radial, ulnar, and musculocutaneous nerves were assessed at regular intervals for 30 minutes after the injection. Successful block was defined as being able to complete surgery under the BPB. RESULTS: The CCS was visualized as a well-defined intermuscular space lying deep and posterior to the mid-point of the clavicle. The cords of the brachial plexus were clustered together lateral to the axillary artery within the CCS. The costoclavicular BPB was successfully performed in all patients, and the median onset time for sensory and motor blockade of all the 4 nerves was 5 [5-15] and 5 [5-10] minutes, respectively. Complete sensory blockade of all the 4 nerves was achieved in 30 [20-30] minutes, and the BPB was successful in 29 (97%) of 30 patients. There were no complications directly related to the technique or the local anesthetic injection. CONCLUSIONS: This report describes a novel technique of infraclavicular BPB at the costoclavicular space that produces rapid onset of BPB. Future research should compare the safety and efficacy of this new technique with the traditional lateral sagittal infraclavicular BPB. SN - 1532-8651 UR - https://www.unboundmedicine.com/medline/citation/28157792/Ultrasound_Guided_Costoclavicular_Brachial_Plexus_Block:_Sonoanatomy_Technique_and_Block_Dynamics_ L2 - https://rapm.bmj.com/lookup/pmidlookup?view=long&pmid=28157792 DB - PRIME DP - Unbound Medicine ER -