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The vertical infraclavicular brachial plexus block: a simulation study using magnetic resonance imaging
Oivind Klaastad1, Orjan Smedby, Trygve Kjelstrup
1Department of Anesthesiology and The Interventional Centre, Rikshospitalet University Hospital, Sognsvannsveien 20, NO-0027 Oslo, Norway. oivindkl@klinmed.uio.no
Anesthesia and Analgesia
|June 25, 2005
Summary
The vertical infraclavicular brachial plexus block may pose risks, including potential pleural contact, especially in women. Careful needle placement is crucial to avoid pneumothorax and subclavian vessel puncture.
Area of Science:
- Anesthesiology
- Radiology
- Anatomy
Background:
- The vertical infraclavicular approach is a recommended technique for brachial plexus blocks.
- Assessing the safety and precision of this block is essential for clinical practice.
Purpose of the Study:
- To evaluate the risk of pneumothorax and subclavian vessel puncture with the vertical infraclavicular brachial plexus block.
- To determine the precision of the needle trajectory using magnetic resonance imaging (MRI).
Main Methods:
- MRI was performed on 20 adult volunteers to analyze the needle trajectory.
- The study assessed the proximity of the needle path to the pleura, subclavian vessels, and brachial plexus.
Main Results:
- The needle trajectory aimed towards the lung in 6 subjects (5 women).
- Pleural contact was avoidable by stopping needle advancement upon encountering subclavian vessels, plexus, or the first rib.
- Subclavian vein and artery were contacted in 3 and 5 subjects, respectively. The median distance to the brachial plexus was 1 mm, with nerve contact in 9 subjects.
Conclusions:
- A small risk of pleural contact exists with this block, particularly in women.
- There is a high probability of subclavian vessel contact.
- Precise landmark identification and needle insertion are critical for safe and effective brachial plexus blockade.