Interscalenic approach to the cervico-brachial plexus

Area of Science:

• Anesthesiology and Pain Medicine
• Regional Anesthesia Techniques
• Neuroanatomy and Physiology

Background:

• The cervicobrachial plexus is crucial for innervation of the upper extremities and neck.
• Traditional plexus blockade techniques can be complex and time-consuming.
• A closed peri-neurovascular space concept offers a simplified approach to plexus anesthesia.

Purpose of the Study:

• To describe A. Winnie's single-puncture technique for cervicobrachial plexus blockade.
• To highlight the advantages of this technique, including speed, simplicity, and patient comfort.
• To discuss current and emerging indications for this blockade, such as shoulder surgery and pacemaker implantation.

Main Methods:

• Utilizes the concept of a closed peri-neurovascular space surrounding the cervicobrachial plexus.
• Employs a single puncture technique for blockade of both cervical and brachial plexuses.
• Relies on easily identifiable anatomical landmarks for accurate needle placement.

Main Results:

• The single-puncture technique demonstrates rapidity, simplicity, and enhanced patient comfort.
• Blockade effectiveness and extent are determined by injection level and local anesthetic volume, similar to epidural blockade.
• Low incidence of complications, with Horner syndrome and recurrent laryngeal/phrenic nerve blockade being notable but minor; pneumothorax risk is negligible.

Conclusions:

• Winnie's single-puncture technique provides an efficient and safe method for cervicobrachial plexus blockade.
• This technique is suitable for traditional indications like shoulder surgery and emerging uses such as cardiac pacemaker placement.
• The method offers significant advantages in terms of procedural ease and patient experience compared to traditional approaches.