Novosti
Khirurgii
This journal is
indexed in Scopus









Year 2014 Vol. 22 No 2

NEW METHODS

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.218   |  

A.V. BRUKHNOU, V.G. PIACHERSKI, A.V. MAROCHKOV, Z.V. KOKHAN, A.N. BARDZILOUSKI

ANTERIOR TRANSSCALENE ACCESS TO BRACHIAL PLEXUS WHILE PERFORMING REGIONAL BLOCK

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
References
  1. Marhofer P, Harrop-Griffiths W, Willschke H, Kirchmair L.Fifteen years of ultrasound guidance in regional anaesthesia: Part 2-recent developments in block techniques. Br J Anaesth. 2010 Jun;104(6):673-83.
  2. Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L.. Fifteen years of ultrasound guidance in regional anaesthesia: part 1. Br J Anaesth. 2010 May;104(5):538-46
  3. Neuburger M, Buttner J. Anaesthesist. 2011 Nov;60(11):1014-26. [Complications of peripheral regional anesthesia].[Article in German]
  4. Rafmell Dzh.R, Nil DzhM, Viskoumi KM. Regionarnaia anesteziia: samoe neobkhodimoe v anesteziologii [Regional anesthesia: the most necessary in anesthesiology]. Per. s angl; Moscow, RF: MEDpress-inform; 2007. 272 p.
  5. Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B, Mercier FJ, Bouaziz H, Samii K.Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002 Nov;97(5):127480.
  6. Piacherski V, Marochkov A, Brukhnou A, Kokhan Z. Comparison of three methods of regional anesthesia of peripheral nerves and plexuses. OJ Anes. 2012;2(5):23743.
  7. Pecherskii VG, Marochkov AV. Osobennosti rasprostraneniia mestnogo anestetika pri blokade sedalishchnogo nerva [The peculiarities of local anesthetic distribution in blockade of the sciatic nerve]. Novosti Khirurgii. 2011;19(3): 9195.
  8. Maier G, Biuttner I. Perifericheskaia regionarnaia anesteziia: atlas [Peripheral regional anesthesia: an atlas]. per s angl.; red. Kamchatnov PR. Moscow, RF: BINOM. Laboratoriia Znanii; 2010. 260 p.
  9. Chelly JE. Peripherial nerve blocks: a color atlas. 3rd ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2009. p. 1474.
  10. Kovanov VV. Operativnaia khirurgiia i topograficheskaia anatomiia [Operative surgery and topographic anatomy]. Moscow, RF: Meditsina; 1977. 415 p.
  11. Sinel'nikov RD. Atlas anatomii cheloveka. Uchenie o nervnoi sisteme, organakh chuvstv i organakh vnutrennei sekretsii [Atlas of human anatomy. Doctrine of the nervous system, sensory organs and organs of internal secretion]. Moscow, RF: Meditsina; 1974;(3):399 p.
  12. Geert-Jan van Geffen. The value of ultrasonography for performing peripheral nerve blocks. In: Theory, practice and clinical experience in adults and children. Optima Grafische Communicatie, Rotterdam, NL; 2008. p. 23479.
  13. Moayeri N, Bigeleisen PE, Groen GJ. Quantitative Architecture of the Brachial Plexus and Surrounding Compartments, and Their Possible Significance for Plexus Blocks. Anesthesiology. 2008;108(2):29904.
  14. Verma AK, Sah MK, Agarwal A, Singh C. Total spinal anaesthesia with Interscalene brachial plexus block by Winnie approach. Indian J Anaesth. 2013 Mar;57(2):199-201.
  15. Bouaziz H, Iohom G, Estebe JP, Campana WM, Myers RR. Effects of levobupivacaine and ropivacaine on rat sciatic nerve blood flow. Br J Anaesth. 2005 Nov;95(5):696-700.
Address for correspondence:
212026, Respublika Belarus', g. Mogilev, ul. B.-Biruli, d. 12. UZ Mogilevskaia oblastnaia bol'nitsa, otdelenie anesteziologii i reanimatsii,
e-mail: andreibruhnov@gmail.com,
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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