The brachial plexus in the human body originates from the roots of the anterior spinal nerves and consists of formations that go to the upper limb. Next, we will talk in detail about the types of blockade of this plexus.
Types of blockade
The following types of blockades are distinguished:
- Interstairs.
- Axillary.
- Supraclavicular.
- Subclavian.
Supraclavicular block: rules, technique and indications
In the supraclavicular region, the brachial plexus lies between the clavicle and the rib, which occurs in close proximity to the subclavian artery, located behind the anterior scalene muscles. In relation to the artery, the plexus is located laterally. The indications for a supraclavicular brachial plexus block are as follows:
- For operations in the area of the lower third of the shoulder.
- Against the background of operations on the elbow joints.
- For intervention on the forearm.
- Whenoperations on the hand.
Supraclavicular blockade of the brachial plexus can be performed using the search for the nervous structure using paresthesia, using a neurostimulator, as well as using assisted techniques. To perform a supraclavicular block using the paresthesia method as a plexus verification, the equipment includes:
- Manipulation needle (3 cm long blunt needle).
- Connecting tube.
- A couple of 20 ml syringes for blockade.
- Syringe with a needle for local anesthesia of the skin.
- Sterile balls with napkins.
When using the plexus search technique using a neurostimulator, the kit includes the neurostimulator itself, equipped with a surface electrode, and in addition, a special insulated needle with a puncture point. As part of the use of assisted technology, a linear sensor for tangle detection is also included in the equipment.
Drugs for supraclavicular blockade
Almost any local anesthetic can be used for this brachial plexus block. The required volume of anesthetic to perform a blockade by supraclavicular access, as a rule, is 50 milliliters, in accordance with this, the concentration of the drug is calculated, taking into account its maximum allowable doses and the presence of vasopressors in the anesthetic solution. In the opinion of experts, the addition of adrenaline is desirable, as it improves the quality ofthe duration of the blockade, and in addition, slows down the absorption of local anesthetic.
Complications and prevention of supraclavicular blocks
Arterial puncture may indicate that the needle is moving anteriorly. Manipulation in itself is not dangerous, however, a hematoma may form. When puncturing the artery, the needle is removed. To ensure hemostasis, strong pressure is used in the puncture area for five minutes. After this, attempts to localize the plexuses are repeated, moving slightly back, the needle is inserted in the same direction.
The initial injection of a small amount of solution during intraneural injections allows you to diagnose the location of the needle in order to prevent possible adverse effects. With the introduction of a large volume of anesthetic, the development of long-term neuropathy is likely.
Pneumothorax can occur at a rate of three percent. With the correct selection of the direction of the needle, its occurrence is practically excluded. In cases of its development, a typical clinical picture may appear. In doubtful situations, a chest x-ray may be needed to rule it out. Therapy in this case directly depends on the volume, and in addition, on the rate of development of the complication.
What other brachial plexus block techniques are known?
Interscalene blockade: rules, technique and indications
This brachial plexus comes out in humans between the middle and anterior scalene muscles. At this level, the brachial plexus appears as trunks. On theat the level of the interscalene spaces, the middle and superior plexus roots are well accessible, which explains the lack of anesthesia of the ulnar nerves with this type of blockade. The anatomical reference point for inserting the needle is the interstitial spaces.
Indications for this blockade of the brachial plexus are surgical interventions in the region of the shoulder and shoulder girdle. The absence of an ulnar nerve block allows the use of this technique for intervention on the forearm and hands only in combination with an additional blockade of the ulnar nerves.
Interscalene blockade of the brachial plexus is performed using the search for the nervous structure using paresthesias, neurostimulators, as well as using assisted techniques. To perform interscalene blockade using paresthesia techniques as plexus verification, the equipment includes:
- Manipulation needle (blunt needle up to four centimeters).
- Use of connecting tube.
- Using two 20 ml syringes for blockade.
- Using a syringe and needle for local anesthesia of the skin.
- Using wipes.
When using the plexus search technique using a neurostimulator, the kit includes an electrode with a special insulated needle with a short tip for punctures. When using assisted technology, the equipment additionally includes a linear sensor to search for plexuses.
Technique for performing interstitialblockades
As part of the blockade of the brachial plexus by interscalene access, the patient is placed in the supine position, and his head should be slightly turned in the opposite direction. In this case, the arms are brought to the body and rotated from the outside. Next, the injection sites are processed.
Then, anatomical landmarks are determined (we are talking about the cricoid cartilage, the lateral edge of the sternum muscle and the interstitial recess). The tubercle projection area is marked. Next, intradermal anesthesia is performed.
Axillary brachial plexus blockade: rules, technique and indications
In the axillary region, the brachial plexus is represented by three bundles, namely the posterior, lateral and medial, they are so named because of the axillary artery. All these bundles are located near the axillary artery, which is the main landmark for this blockade. Indications for blockade of the brachial plexus by axillary access are operations on the forearm along with surgical interventions on the hands.
This blockade is carried out using the search for the nervous structure using anatomical landmarks, paresthesia, a neurostimulator, and in addition, using assisted techniques. To perform a subclavian block using an anatomical landmark technique or paresthesias as verification of the plexus, the equipment usually includes:
- Needle for manipulation (blunt needle up to three centimeters).
- Applicationconnecting tube.
- Using two 15ml syringes for blockade.
- Using a syringe and needle for local anesthesia of the skin.
- Using sterile wipes.
When using the technique of finding the plexus using a neurostimulator, the kit includes a device equipped with a surface electrode along with a special insulated needle up to five centimeters long. When using assisted technology, a linear sensor is included in the equipment.
Axillary Blockade Technique
As part of an axillary brachial plexus block, the technique includes the following steps:
- The patient is placed in the supine position, the head is slightly turned in the opposite direction, and the arm on the intervention side is moved ninety degrees and flexed at the elbow joint.
- Next, the injection area is treated and isolated with sterile underwear.
- The axillary artery is palpated, which is done as proximal as possible.
- Local infiltration anesthesia is performed.
- Then the artery is fixed with fingers.
It should be said that the transarterial technique is the most common along with the technique of perivascular infiltrations.
Subclavian blockade: rules, technique and indications
Let's take a closer look at the technique of subclavian brachial plexus blockade.
At the level of the subclavian fossae, the brachial plexusrepresented by three bundles at once. The plexus bundles can pass in a single fascial sheath along with the subclavian vein and artery. The subclavian fossae proper are delimited: in front they are limited by the small and large pectoral muscles, in the middle by the ribs, and from above by the coracoid process and the clavicle, and in addition, by the humerus. Indications for a blockade are usually as follows:
- Operations on the elbow joint.
- Performing operations on the forearm.
- Carrying out operations on the hands.
Subclavian blockade can be performed using the search for the nervous structure using paresthesias and assisted techniques. To perform such a blockade, the equipment includes:
- Needle for manipulation (blunt needle ten centimeters long).
- Connecting tube.
- Two 20 ml syringes for blockade.
- Needle and syringe for local skin anesthesia.
Subclavian block technique
The technique for performing this type of blockade includes the following techniques:
- The patient is placed in the supine position, the patient's head is slightly turned in the opposite direction, and the arm on the intervention side is abducted and bent at the elbow joint by ninety degrees.
- The injection site is being treated along with its isolation with sterile underwear.
- Next, an anatomical landmark is determined.
- The needle entry point is ontwo centimeters medial and caudal to the lateral margins of the coracoid process.
The article covered the basic techniques of brachial plexus blocks.
