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Ultrasound-guided Single Needle Tip Placement Below Axillary Artery in the Infraclavicular Area: A Cadaveric Study

Overview
Journal J Anaesthesiol Clin Pharmacol
Specialty Anesthesiology
Date 2023 Feb 13
PMID 36778830
Authors
Sandeep Diwan
Georg Feigl
Abhijit Nair
Affiliations
Soon will be listed here.
Abstract

Background And Aims: The parasagittal ultrasound-guided infraclavicular block (ICB) aims to cover all the elements of brachial plexus for the surgeries at and below the elbow. Our aim was to demonstrate the spread of 20 ml latex in vicinity of brachial plexus cords after injecting posterior to the axillary artery in Thiel embalmed cadavers.

Material And Methods: A blunt insulated needle was inserted posterior to the axillary artery in a traditional parasagittal infraclavicular in 2 Thiel embalmed cadavers, on both the sides (four specimens). A day later cadaver 1 was dissected and cadaver 2 was frozen at ‒20ºC for 2 weeks and sectioned. Both cadavers were photographed.

Results: In cadaver 1, dissection revealed a spread of red latex on the lateral cord extending onto the musculocutaneous nerve, the posterior cord engulfing the radial and axillary nerves distally. In cadaver 2, a cross-section revealed latex engulfed all three cords.

Conclusion: Single injection of 20 ml latex aimed posterior to the axillary artery in the parasagittal infraclavicular approach engulfed the posterior, medial and lateral cord in Thiel embalmed cadavers. This needs to be investigated in patients who receive ICB clinically and using contrast studies.

Citing Articles

Ultrasound-guided Parasagittal Infraclavicular Block for Patients without Neurostimulation Endpoints: A Case Report in Crush Injuries of the Upper Limb.

Diwan S, Dongre H, Bhong G, Sancheti P J Med Ultrasound. 2024; 32(2):183-185.

PMID: 38882608 PMC: 11175369. DOI: 10.4103/jmu.jmu_92_22.

References
1.
Sauter A, Smith H, Stubhaug A, Dodgson M, Klaastad O . Use of magnetic resonance imaging to define the anatomical location closest to all three cords of the infraclavicular brachial plexus. Anesth Analg. 2006; 103(6):1574-6. DOI: 10.1213/01.ane.0000242529.96675.fd. View
2.
Ootaki C, Hayashi H, Amano M . Ultrasound-guided infraclavicular brachial plexus block: an alternative technique to anatomical landmark-guided approaches. Reg Anesth Pain Med. 2000; 25(6):600-4. DOI: 10.1053/rapm.2000.18184. View
3.
Feigl G, Anderhuber F, Schwarz G, Dorn C, Fasel J, Likar R . [Training methods for regional anaesthesia. Evaluation and comparison]. Anaesthesist. 2007; 56(5):437-43. DOI: 10.1007/s00101-007-1149-1. View
4.
Porter J, McCartney C, Chan V . Needle placement and injection posterior to the axillary artery may predict successful infraclavicular brachial plexus block: a report of three cases. Can J Anaesth. 2004; 52(1):69-73. DOI: 10.1007/BF03018583. View
5.
Bloc S, Garnier T, Komly B, Asfazadourian H, Leclerc P, Mercadal L . Spread of injectate associated with radial or median nerve-type motor response during infraclavicular brachial-plexus block: an ultrasound evaluation. Reg Anesth Pain Med. 2007; 32(2):130-5. DOI: 10.1016/j.rapm.2006.11.012. View