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Year 2014 Vol. 22 No 2


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ME Mogilev Regional Hospital,
The Republic of Belarus

Objectives. This report focuses on an area of practice increases safety of a regional brachial plexus blockage performed according to anatomical landmarks with electrical stimulation of the peripheral nerves but without ultrasonograpy by means of development of a new anterior transscalene approach for brachial plexus block.
Methods. The advantages and disadvantages of different generally recognized accesses for transscalene brachial plexus block: the brachial plexus in the interscalene space: access according to Winnie, Meier and posterior access according to Pippa have been analyzed. Mutual arrangement of the brachial plexus trunks and other anatomical abnormalities in the neck area has been evaluated.
The access to the brachial plexus according to the anatomical landmarks (the sternal head of a sternocleidomastoid muscle, the clavicular head of the sternocleidomastoid muscle, the cricoid, the jugular notch, the interscalene groove) when the risk of large vessels damage as well as the dome of the pleura and the development of total spinal anesthesia will consider to be minimal.
Results. The main difference of proposed access to the brachial plexus from the widely known techniques of Winnie and Meier is the direction of the injection needle into the opposite side of the main vessels, the dome of the pleura, the spinal canal, which undoubtedly increases the block safety performance. The designed access was used to perform brachial plexus block with 1% lidocaine by the anatomical landmarks, using a peripheral nerve stimulator without the ultrasound visualization. Blocks were done for anesthesia maintenance of surgical interventions for the shoulder joint injuries, fractures of the clavicle and proximal shoulder sections in 20 patients. Regional anesthesia with the developed access use in all 20 cases was accompanied by a complete motor and sensory block. No complications were observed.
Conclusions. When using ultrasound imaging during regional block is impossible, the proposed access can be an alternative to the classical variants of the brachial plexus access. In the case of impossibility of performance of ultrasound visualization in regional block the proposed approach can be considered as the alternative classic variant of access to the brachial plexus.

Keywords: anterior transscalene access, brachial plexus block, electrical stimulation of peripheral nerves, anatomical landmarks
p. 218 223 of the original issue
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Address for correspondence:
212026, Respublika Belarus', g. Mogilev, ul. B.-Biruli, d. 12. UZ Mogilevskaia oblastnaia bol'nitsa, otdelenie anesteziologii i reanimatsii,
Brukhnou Andrei Viktorovich
Information about the authors:
Brukhnou A.V. An anesthesiologist-reanimatologist, of the anesthesia and resuscitation department of ME Mogilev regional hospital.
Piacherski V.G. An anesthesiologist-reanimatologist, anesthesia and resuscitation department of ME Mogilev regional hospital.
Marochkov A.V. MD, professor, a head of anesthesia and resuscitation department of ME Mogilev regional hospital.
Kokhan Z.V. An anesthesiologist-reanimatologist, anesthesia and resuscitation department of ME Mogilev regional hospital.
Bardzilouski A.N. An anesthesiologist-reanimatologist, anesthesia and resuscitation department of ME Mogilev regional hospital.
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