Abstract
Purpose: To ultrasonically identify the presence of septae within the neurovascular sheath and to assess their effect on local anesthetic spread when performing infraclavicular brachial plexus blocks.
Clinical features: Thirty ASA status I and II patients scheduled for minor hand surgeries were enrolled in the study. Ultrasound guided infraclavicular brachial plexus blocks were performed on 28 patients. The images of the local anesthetic spread and the effect of the septum within the neurovascular sheath were analyzed. Septae were present in four of six patients where unilateral local anesthetic spread was seen. Septae were not visualized in the 22 patients with unrestricted local anesthetic spread after the initial injection. All 28 patients underwent their planned operations successfully with adequate anesthesia.
Conclusions: Our study shows that the presence of septae within the neurovascular sheath may influence the pattern of local anesthetic spread associated with the infraclavicular approach to brachial plexus blocks.
Résumé
Objectif: Identifier par échoguidage la présence de septa dans la gaine neurovasculaire et évaluer leur effet sur la diffusion de l’anesthésique local lors de blocs infraclaviculaires du plexus brachial.
Éléments cliniques: Trente patients ASA statut I et II devant subir des chirurgies mineures de la main ont participé à cette étude. Vingt-huit patients ont eu des blocs infraclaviculaires du plexus brachial échoguidés. Les images de la diffusion de l’anesthésique local et l’effet du septum dans la gaine neurovasculaire ont été analysés. Des septa étaient présents chez quatre des six patients chez qui on avait observé une diffusion unilatérale de l’anesthésique local. Aucun septum n’a été observé chez les 22 patients où la propagation de l’anesthésique local n’a pas été restreinte après l’injection initiale. Les chirurgies prévues chez les 28 patients se sont bien déroulées avec une anesthésie satisfaisante.
Conclusion: Notre étude montre que la présence de septa dans la gaine neurovasculaire peut influencer le mode de diffusion de l’anesthésique local associé à une approche infraclaviculaire pour les blocs du plexus brachial.
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Morimoto, M., Popovic, J., Kim, J.T. et al. Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks. Can J Anesth 54, 1006–1010 (2007). https://doi.org/10.1007/BF03016635
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DOI: https://doi.org/10.1007/BF03016635