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Ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for vascular access surgery.
J Vasc Access. 2017 Sep 11; 18(5):e57-e61.JV

Abstract

INTRODUCTION

We report the use of a newly described regional technique, ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for surgical anesthesia in two high-risk patients undergoing 2nd stage transposition of basilic vein fistula.

METHODS

Both patients had features of difficult airway, American Society of Anesthesiologists (ASA) physical status class III and central venous occlusive disease. The common approach, i.e., ultrasound-guided supraclavicular brachial plexus block was technically difficult with inherent risk of vascular puncture due to dilated venous collaterals at the supraclavicular area possibly compromising block quality. The risk of general anesthesia (GA) was significant as patients were morbidly obese with possible risk of obstructive sleep apnea postoperatively. As an alternative, we performed the ultrasound-guided costoclavicular approach infraclavicular brachial plexus block with 20 mL local anesthetic (LA) ropivacaine 0.5% delivered at the identified costoclavicular space using in-plane needling technique. Another 10 mL of LA was infiltrated along the subcutaneous fascia of the proximal medial aspect of arm.

RESULTS

Both surgeries of >2 hours' duration were successful, without the need of further local infiltration at surgical site or conversion to GA.

CONCLUSIONS

Ultrasound-guided costoclavicular approach can be an alternative way of providing effective analgesia and safe anesthesia for vascular access surgery of the upper limb.

Authors+Show Affiliations

Department of Anesthesia and Intensive Care, Kuala Lumpur General Hospital, Kuala Lumpur - Malaysia.Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur - Malaysia.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28478621

Citation

Beh, Zhi Yuen, and Mohd Shahnaz Hasan. "Ultrasound-guided Costoclavicular Approach Infraclavicular Brachial Plexus Block for Vascular Access Surgery." The Journal of Vascular Access, vol. 18, no. 5, 2017, pp. e57-e61.
Beh ZY, Hasan MS. Ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for vascular access surgery. J Vasc Access. 2017;18(5):e57-e61.
Beh, Z. Y., & Hasan, M. S. (2017). Ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for vascular access surgery. The Journal of Vascular Access, 18(5), e57-e61. https://doi.org/10.5301/jva.5000720
Beh ZY, Hasan MS. Ultrasound-guided Costoclavicular Approach Infraclavicular Brachial Plexus Block for Vascular Access Surgery. J Vasc Access. 2017 Sep 11;18(5):e57-e61. PubMed PMID: 28478621.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for vascular access surgery. AU - Beh,Zhi Yuen, AU - Hasan,Mohd Shahnaz, Y1 - 2017/09/11/ PY - 2017/02/13/accepted PY - 2017/5/10/pubmed PY - 2018/5/23/medline PY - 2017/5/8/entrez SP - e57 EP - e61 JF - The journal of vascular access JO - J Vasc Access VL - 18 IS - 5 N2 - INTRODUCTION: We report the use of a newly described regional technique, ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for surgical anesthesia in two high-risk patients undergoing 2nd stage transposition of basilic vein fistula. METHODS: Both patients had features of difficult airway, American Society of Anesthesiologists (ASA) physical status class III and central venous occlusive disease. The common approach, i.e., ultrasound-guided supraclavicular brachial plexus block was technically difficult with inherent risk of vascular puncture due to dilated venous collaterals at the supraclavicular area possibly compromising block quality. The risk of general anesthesia (GA) was significant as patients were morbidly obese with possible risk of obstructive sleep apnea postoperatively. As an alternative, we performed the ultrasound-guided costoclavicular approach infraclavicular brachial plexus block with 20 mL local anesthetic (LA) ropivacaine 0.5% delivered at the identified costoclavicular space using in-plane needling technique. Another 10 mL of LA was infiltrated along the subcutaneous fascia of the proximal medial aspect of arm. RESULTS: Both surgeries of >2 hours' duration were successful, without the need of further local infiltration at surgical site or conversion to GA. CONCLUSIONS: Ultrasound-guided costoclavicular approach can be an alternative way of providing effective analgesia and safe anesthesia for vascular access surgery of the upper limb. SN - 1724-6032 UR - https://www.unboundmedicine.com/medline/citation/28478621/Ultrasound_guided_costoclavicular_approach_infraclavicular_brachial_plexus_block_for_vascular_access_surgery_ L2 - https://journals.sagepub.com/doi/10.5301/jva.5000720?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -