Lateral Vs Classical Approach of Supraclavicular Brachial Plexus Block for Orthopedic Surgeries below Mid-Humerus: A Comparative Study.

Introduction: Supraclavicular brachial plexus blockwith classical approach is used to provide anaesthesia fororthopaedic upper limb surgeries. This approach is safe but notdevoid of complication, therefore we compared a alternativelateral approach with classical approach in terms of sensoryand motor blockade, tourniquet tolerance and complication.Material and Methods: After obtaining the ethics committeeapproval 64 patients posted for orthopaedic surgeries belowmid humerus under supraclavicular block were enrolled. Theywere divided into two groups (32 each), Group C receivedclassical approach and Group L received lateral approachwith the help of nerve stimulator. A mixture of adrenalized2% lignocaine (5-7mg/kg) and plain 0.5% bupivacaine (2mg/kg)(total volume 30 ml) was used. Onset time of sensory andmotor block, duration of sensory and motor block, durationof analgesia, tourniquet tolerance and complications (if any)were noted and compared in both the groups. Quantitative datawere compared by using unpaired T test and qualitative databy using Chi-Square test and Fisher’s Exact test (2X2 tables).Results: The mean times to onset of sensory and motorblockade and the mean duration of sensory and motorblockade did not differ between the two groups. Mean durationof analgesia with lateral approach is found to be longer butstatistically not significant. Tourniquet tolerance was goodand no pneumothorax observed in lateral approach.Conclusion: Lateral approach has shown to be a safealternative to classical approach for supraclavicular brachialplexus block in terms of adequacy of block, tourniquettolerance and complications.

A comparative study of supraclavicular versus infraclavicular approach for central venous catheterization in neurosurgical patients

Background: Central venous cannulation is a commonly performed procedure in neurosurgical patients to maintain the hemodynamic stability in the intraoperative period. It is used for infusion of intravenous fluids, vasopressors central venous pressure monitoring and detection of air embolism. Subclavian vein is commonly performed as there are minimal effects of positioning on it. Supraclavicular approach to subclavian vein cannulation is not as frequently employed as the infraclavicular approach. The purpose of this study was to compare the supraclavicular approach versus the infraclavicular approach in terms of number of attempts, success rate of catheterization and complications associated with the procedure.Methods: About 150 patients undergoing various neurosurgical procedures were enrolled in the study. They were divided into two groups. 75 patients underwent right supraclavicular catheterization of subclavian vein while as 75 patients underwent right infraclavicular catheterisation of the subclavian vein. The number of attempts for cannulation, success or failure of catheterization and any complications associated with the procedure or in the postoperative period were noted in each group. The data was compared between the two groups by using Chi-square test and Student’s Independent Samples T-test.Results: The right supraclavicular vein was successfully cannulated in 90.66% while as the right infraclaviclar vein was successfully cannulated in 96% of the patients (p >0.05). Malpositioning of catheter (threaded in contralateral subclavian) was noted in 4 patients in Group S and ipsilateral internal jugular vein in 2 patients. Pneumothorax was encountered in 1 patient in the group S undergoing supraclavicular subclavian vein cannulations while as subclavian arterial puncture was seen in 4 patients who underwent infraclavicular arterial puncture.Conclusions: There was no difference in successive cannulations between right the supraclavicular and right infraclaviclar veins. The rate of complications between the two approaches was comparable.

Addition of Methylprednisolone to Local Anaesthetics in Brachial Plexus Block (Supraclavicular Approach): A Randomised Double Blind Study

Introduction: Various additives have been added in brachialplexus block with local anaesthetics to increase their duration.We performed a randomised prospective double blind study toevaluate the effect of methylprednisolone added to lidocaineand bupivacaine on the onset and duration of anaesthesia.Method: 60 patients with ASA physical status 1 and 2 with age18 to 60 years undergoing elective upper arm surgery belowelbow were randomly allotted to receive either 20 ml (0.5%)bupivacaine + 10 ml lidocaine (2%) + 40 mg (1ml)methylprednisolone or 20 ml (0.5%) bupivacaine + 10 mllidocaine (2%) +1ml normal saline. Block was performed undernerve stimulator guidance. Onset and duration of motor andsensory blockade was done.Results: Onset of sensory and motor blockade (4.5 ± 1.43minutes vs 7.81 ± 1.42 minutes and 9.03 ± 2.48 mins vs 11.27± 2.86 mins) respectively was significantly more rapid inmethylprednisolone group. The duration of sensory and motorblockade (911 ± 112.4 mins vs 396.83 ± 64.28 mins and 456.5± 79.4 mins vs 225 ± 49.39 mins) respectively weresignificantly longer in methylprednisolone group.Conclusion: Addition of methylprednisolone to brachial plexusblock speeds the onset and prolongs the duration of sensoryand motor blockade.

The clinical application of the open supraclavicular approach in thyroidectomy / 中国肿瘤临床

Objective: To analyze the clinical application of the open supraclavicular approach in thyroidectomy. Methods: The clinical practicability of open supraclavicular thyroidectomy was explored by comparing the traditional anterior low arc incision thyroidectomy procedure with open supraclavicular thyroidectomy in terms of patients'aesthetic satisfaction, effectiveness of the operation, operation time, and so on. Result: Twenty-two cases of open supraclavicular thyroidectomy (group B) had better aesthetic satisfaction than 29 cases of traditional incision thyroidectomy (group A)(P<0.05), and had the same operative effect with traditional incision. Open supraclavicular thyroidectomy is associated with good aesthetic satisfaction, and has the same effect as the traditional incision does. Conclusions: Open supraclavicular thyroidectomy has good clinical value for benign thyroid tumors and some malignant tumors that require unilateral lobectomy, and even for tumors larger than the incision diameter. It has good aesthetic value while ensuring the curative effect of surgery.

Aneurisma del tronco tirocervical / Thyrocervical trunk aneurysm

El aneurisma de la arteria subclavia es una entidad extremadamente rara que no sobrepasa el 1 % del total de los aneurismas periféricos y pueden situarse en diferentes sectores de la arteria. El objetivo de este trabajo es describir el diagnóstico y tratamiento empleado en un paciente portador de un aneurisma verdadero del tronco tirocervical derecho, rama de la arteria subclavia, considerado como infrecuente. Se trata de una paciente femenina de 48 años de edad, con antecedentes de aumento de volumen en la zona supraclavicular derecha, tumoración que late y se expande sin trauma previo en dicha zona. Las manifestaciones clínicas consistieron en dolor y parestesias que se irradiaban al miembro superior derecho. A través de estudios ultrasonográficos (ecodoppler y angioTac) se le diagnosticó un aneurisma del tronco tirocervical derecho, rama de la primera porción de la arteria subclavia. Fue intervenida quirúrgicamente en el Instituto Nacional de Angiología y Cirugía Vascular. Se realizó una aneurismectomía y ligadura proximal y distal utilizando un abordaje supraclavicular. Se encontró un aneurisma verdadero de la arteria señalada. Los estudios ultrasonográficos permitieron un diagnóstico certero del problema. La técnica quirúrgica utilizada fue exitosa y la paciente mostró una evolución satisfactoria, sin complicaciones hasta el momento actual con regresión de sus síntomas clínicos(AU)

The subclavian artery aneurysm is an extremely rare disease that barely accounts for 1 % of all peripheral aneurysms and may be located in different sectors of the aorta. The objective of this paper was to describe the diagnosis and treatment used in a patient carrying an unusual true aneurysm of the right thyrocervical trunk, the subclavian artery branch. The case of 48 years-old woman, with a history of raised volume of the right supraclavicular area, beating tumor that expands, and no previous trauma in the area. The clinical symptoms were pain and parestesias irradiating to the right upper member. Through the ultrasonographic studies (Ecodoppler and AngioTac), she was diagnosed a right thyrocervical trunk aneurysm, branch of the first portion of the subclavian artery. She was operated on at the National Institute of Angiology and Vascular Surgery. She underwent aneurysmectomy and proximal and distal ligature by using supraclavicular approach. A true aneurysm of the referred artery was found. The ultrasonographic studies allowed a precise diagnosis of the problem and the surgical procedure was successful. The patient recovered satisfactorily with no complications up to the present and regression of her clinical symptoms(AU)

Comparison of Axillary and Supraclavicular Approach in Ultrasound-Guided Brachial Plexus Block

PURPOSE: We examined the success rate and adverse effects of ultrasound-guided axillary and supraclavicular approach brachial plexus block. METHODS: From December 2013 to February 2014, 580 cases of patients received ultrasound-guided axillary approach or supraclavicular approach brachial plexus block. All blocks were performed by one anesthesiologist under ultrasound visualization using 0.2% or 0.75% ropivacaine 1% lidocaine with epinephrine in 1:200,000 as the anesthetic mixture. RESULTS: Failure rate of ultrasound-guided brachial plexus block was 1.2% and 0.2% in axillary and supraclavicular approach, respectively. In supraclavicular approach brachial plexus block, Honer's syndrome was observed in 17.9%, chest discomfort in 14.9%, and arterial puncture in 1%. There was no adverse effect in axillary approach brachial plexus block. CONCLUSION: Ultrasound-guided brachial plexus block serves higher success rate and lower occurrence rate of adverse effect and makes it useful for hand and upper extremity surgery. Supraclavicular approach has relatively higher success rate and lower rate of adverse effect than axillary approach.

Supraclavicular subclavian venous catheterization through the insertion point medial to the middle of clavicle in infants / 中华麻醉学杂志

Objective To evaluate the effectiveness and safety of percutaneous subclavian venous catheterization through the point of insertion medial to the middle of clavicle in infants.Methods One hundred and fifty infants(88 male,62 female)aged 1-12 months scheduled for major operation were enrolled in this study. Subclavian venous catheterization was performed via supraclavicular approach.The needle was inserted at a point midway between the middle of clavicle and the inner third of clavicle(group Ⅰ,n=50)or at the point where the posterior border of sterno-cleidomastoid muscle(SCM)meets the upper border of clavicle(Yoffa method group Ⅱ, n=50)or at the posterior border of SCM,0.5-1.0 cm above the upper border of clavicle(modified James method,group Ⅲ,n=50).The overall success rate,the success rate at first attempt,the failure rate,the depth of insertion and complications were recorded.Results The 3 groups were comparable with respect to sex ratio,age and body weight.There were no significant differences in overall success rate and failure rate among the 3 groups. The success rate at first attempt in group Ⅰ(86%)was significantly higher than that in group Ⅱ(74%)and group Ⅲ(80%)(P＜0.05).The depth of insertion was significantly greater in group Ⅰ[(2.21+0.28)cm]than in group Ⅱ[(1.79?0.33)cm]and group Ⅲ[(1.84?0.38)cm].No pneumothorax and in advertent arterial puncture and nerve injury occurred in the 3 groups.Conclusion Supraclaricular subclavian venous catheterization through the insertion point medial to the middle of clavicle is better than the conventional methods(Yoffa,James) in terms of success rate at first attempt in infants.

Supraclavicular Approach to a Lesion in the Cervico-Thoracic Junction

A lesion in the cervico-thoracic junction can be of interest to neurosugeons, not only because its incidence is quite low, but also because there is not a published proper anterior approach. Currently the authors have experienced two cases of degenerative disease and one case of traumatic dislocation of the cervico-thoracic junction, in which the main lesions were located in the interspace or posterior portion of vertebral bodies at the junction between the cervical and thoracic spines and an anterior approach to the lesions should be considered. A supraclavicular approach has applied to these cases, by which a good surgical field was obtained. Furthermore the surgical results were good without any serious complication.

Clinical Evaluation of Supraclavicular Block ; Influence of Injected Volume of Bupivacaine on Neural Blockade / 대한마취과학회지

Brachial plexus block is frequently used for surgery on the upper extremity. Unsuccessful brachial plexus block is usually caused either by injection outside the neurovascular sheath or by incomplete blockade inspite of injection within the neurovascular sheath. Studied by Winnie and Collines suggested that the extent of blockade following injection in the sheath surrounding the brachial plexus also should be directly proportional to the volume of local anesthetic injected. We therefore investigated the extent of blockade using different volume of bupivacaine with supraclavicular approach. The results were as follows. 1) Complete analgesia was observed between the group of 15 ml and 30 ml. 2) The interval of complaint of pain after a single injection ranged from 14.3 to 16.4 hours. Insignifi-cant difference was found between the group of 15 ml and 30 ml (p> 0.1) 3) There was no hematoma, shivering, but there was Horner's syndrome in 13, phrenic N.paralysis in 2, pneumothorax in 1 cases. No general seizure or other side effects were observed. Therefore we come to the conclusion that above the volume of 15 ml is sufficient to brachial plexus block with supraclavicular approach.