Application of supraclavicular fossa puncture in coracoid approach brachial plexus block guided by ultrasound / 临床麻醉学杂志

Objective To evaluate the clinical effect of supraclavicular fossa puncture in coracoid approach brachial plexus block under ultrasonic guidance.Methods Sixty patients scheduled for distal upper extremity surgery, male 33 and female 27, BMI 18.5-28.0 kg/m2, aged 18-60 years old, falling into ASA physical statusⅠ-Ⅲ, were randomly divided into groups A and B, 30 cases in each.Coracoid approach brachial plexus block was carried out under ultrasonic guidance.The puncturing point was located in infraclavicula (group A) or supraclavicular fossa (group B), and 0.5％ropivacaine 20 ml was injected around axillary artery for each patient.The procedure time and the number of needle adjustment were recorded as primary outcome, and the onset time, sensory block score at 15 min after injection, the success rate of block and the incidence of complications were noted also.Results Compared with group A, the procedure time was shorter in group B (P<0.05).There was no significant difference in the number of needle adjustment, onset time, sensory block score at 15 min, the success rate of block and incidence of complications between the two groups.Conclusion Puncturing through supraclavicular fossa can shorten the procedure time of coracoid approach brachial plexus block guided by ultrasound.It is effective and safe, and does not increase the complications.

Bilateral supernumerary sternocleidomastoid heads with critical narrowing of the minor and major supraclavicular fossae: clinical and surgical implications / Cabezas supernumerarias bilaterales del músculo esternocleidomastoídeo con estrechamiento crítico de las fosas supraclavicular menor y mayor: implicancias clínicas y quirúrgicas

Anatomical variations of the sternocleidomastoid muscle are rare and concern its origin, insertion, and the number of heads. We report on a rare bilateral variant of the sternocleidomastoid muscle with aberrant and supernumerary muscular heads, observed in a cadaveric subject. On the right side of the neck, a typical sternomastoid head of the sternocleidomastoid muscle, and three aberrant clavicular heads of variable thickness, origin, and termination were noticed. On the left side, two sternomastoid heads were present; the medial one was of typical pattern, while the lateral was supernumerary. The cleidomastoid portion of the left sternocleidomastoid muscle was fused with the double sternomastoid segment. A strap-like muscle originating from the middle third of the clavicle and inserting onto the transverse process of the C3 vertebra was noticed. This is known as the cleidocervical muscle. On the right side of the neck, the posterior cervical triangle was diminished, the minor supraclavicular fossa was considerably narrow, whereas on the left, it was diminished in addition to a bilateral shortening of the major supraclavicular fossa minimizing space needed for potential surgical access. These findings are of prominent significance for anesthetists in ultrasound guided needle positioning in brachial plexus block, as well as in subclavian or external jugular vein catheterization, and in surgical interventions involving structures lying under the sternocleidomastoid muscle...

Las variaciones anatómicas del músculo esternocleidomastoideo son poco frecuentes y se refieren a su origen, inserción, y número de cabezas. Se presenta una rara variante del músculo esternocleidomastoideo con cabezas musculares aberrantes y supernumerarias bilateralmente en un cadáver. En el lado derecho del cuello, se observaron la cabeza esternomastoidea típica del músculo esternocleidomastoideo, y tres cabezas claviculares aberrantes de origen, espesor y terminación variable. En el lado izquierdo, se observaron dos cabezas esternomastoídeas, la medial con su patrón típico, mientras que el lateral fue supernumeraria. La porción cleidomastoídea del músculo esternocleidomastoideo izquierdo se fusionó con el segmento esternocleidomastoideo doble. Un músculo acintado similar procedentes del tercio medio de la clavícula e inserción en el proceso transverso de la vértebra C3 fue observado. Éste se conoce como el músculo cleidocervical. En el lado derecho del cuello, el triángulo cervical posterior fue disminuido, la fosa supraclavicular menor fue considerablemente estrecha, mientras que en el lado izquierdo, se disminuyó además a un acortamiento bilateral del espacio fosa supraclavicular importante reducir al mínimo necesario para el acceso quirúrgico potencial. Estos hallazgos tienen una importancia destacada para los anestesistas en el posicionamiento de aguja guiada por ecografía en el bloqueo del plexo braquial, así como en la cateterización de la vena subclavia o yugular externa, y en las intervenciones quirúrgicas que afecta las estructuras situadas debajo del músculo esternocleidomastoideo...

Non-Traumatic Organizing Hematoma on Supraclavicular Fossa in a Child: A Case Report / 대한이비인후과학회지

Organizing hematoma occurs in many locations and simulate neoplasms. They have similar histologic features such as having a central mass of blood, granulation tissue, and dense, fibrous tissue at the periphery. There have been sporadic reports of organizing hematoma found not only in the soft tissue but also in the brain, adrenal gland, lung and maxillary sinus. We report a case of nontraumatic organizing hematoma encountered in a child -on the supraclavicular fossa. To our knowledge it is a site that has not been previously reported.