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Singh S, Singh S, Shiromani S. A comparative study between single injection (corner pocket approach) and double injection costoclavicular block: A randomized parallel arm, non-inferiority trial. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024:S2341-1929(24)00077-5. [PMID: 38657951 DOI: 10.1016/j.redare.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/04/2023] [Indexed: 04/26/2024]
Abstract
BACKGROUND Previous studies have shown that ultrasound guided costoclavicular block may require a double shot to provide adequate, rapid sensory and motor blockade. In this trial, we hypothesized that if the corner pocket approach (between axillary artery and median cord) is used instead of the central approach (at the midpoint of the 3 cords) when performing single-shot costoclavicular block, the onset of blockade would be non-inferior to the double-shot technique. METHOD Ninety patients undergoing upper limb surgery were randomized to 2 groups for ultrasound-guided costoclavicular block (CCB) at a tertiary hospital. One group received ultrasound guided single-shot CCB using the corner pocket approach and other received ultrasound guided double-shot - the first shot at the centre of the 3 cords and the second between the axillary artery and the median cord. An observer blinded to group assignment recorded blockade onset time (defined as the time required to achieve a minimal sensorimotor composite score of 14 out of 16 points). RESULTS Of the 101 patients assessed for eligibility, 90 were recruited over period of 1 year (February 2022 to January 2023), with 45 in each group. Onset time was 22.1 ± 3.1 min in the single-shot group and 22.4 ± 2.9 min in the double-shot group. This difference was insignificant (P = .3). CONCLUSION Time to onset of blockade and full anaesthesia are similar in single-shot corner pocket CCB vs double-shot CCB. Further studies are required to determine the minimum effective volume of local anaesthetic required for the described technique.
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Affiliation(s)
- S Singh
- Departamento de Anestesiología del Instituto Indira Gandhi de Ciencias Médicas, Patna, India
| | - S Singh
- Departamento de Anestesiología del Instituto Indira Gandhi de Ciencias Médicas, Patna, India
| | - S Shiromani
- Departamento de Anestesiología del Instituto Indira Gandhi de Ciencias Médicas, Patna, India.
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Perez Herrero MA, Altinpulluk EY, Perez MF, Zamorano CS, Vilches LV, Galluccio F. Ultrasound-guided infraclavicular approach to brachial plexus: A cadaveric study. Indian J Anaesth 2023; 67:1014-1019. [PMID: 38213694 PMCID: PMC10779980 DOI: 10.4103/ija.ija_665_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 01/13/2024] Open
Affiliation(s)
- Maria A Perez Herrero
- Morphological Madrid Research Center (MoMaRC), Ultradissection, Spain EchoTraining School, Madrid, Spain
- Department of Anesthesiology and Reanimation, Clinical University Hospital in Valladolid, Valladolid, Spain
- Human Anatomy Medicine University, Valladolid, Spain
| | - Ece Yamak Altinpulluk
- Morphological Madrid Research Center (MoMaRC), Ultradissection, Spain EchoTraining School, Madrid, Spain
- Outcomes Research Consortium, Cleveland, Ohio, USA
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Mario Fajardo Perez
- Morphological Madrid Research Center (MoMaRC), Ultradissection, Spain EchoTraining School, Madrid, Spain
- Cadaver Lab Universidad Científica del Sur, Peru
| | - Carlos Salazar Zamorano
- Morphological Madrid Research Center (MoMaRC), Ultradissection, Spain EchoTraining School, Madrid, Spain
- Department of Anesthesiology, October 12 University Hospital, Madrid, Spain
| | - Luis Valdes Vilches
- Morphological Madrid Research Center (MoMaRC), Ultradissection, Spain EchoTraining School, Madrid, Spain
- Puerta del Sol Hospital, Marbella, Malaga, Spain
| | - Felice Galluccio
- Morphological Madrid Research Center (MoMaRC), Ultradissection, Spain EchoTraining School, Madrid, Spain
- Fisiotech Lab Studio, Firenze, Italy
- Center for Regional Anesthesia and Pain Medicine (CRAPM), Wan Fang Hospital, Taipei Medical University, Taipei – Taiwan
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Koo CH, Hwang I, Shin HJ, Ryu JH. Hemidiaphragmatic paralysis after costoclavicular approach versus other brachial plexus blocks in upper limb surgery: a meta-analysis. Korean J Anesthesiol 2023; 76:442-450. [PMID: 37127532 PMCID: PMC10562070 DOI: 10.4097/kja.22718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/17/2023] [Accepted: 04/26/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The costoclavicular brachial plexus block (CCB) is a recently established technique that uses the infraclavicular approach and is performed just below the clavicle. This meta-analysis aimed to determine whether CCB can reduce the incidence of hemidiaphragmatic paralysis (HDP), which is a major adverse event related to brachial plexus block (BPB), while yielding comparable block performance as other BPB techniques. METHODS We searched electronic databases to identify relevant studies that compared the incidence of HDP between CCB and other BPB techniques. The primary outcome was the incidence of HDP following CCB and other BPB techniques. The secondary outcomes were pulmonary function test results, other adverse events, and block performance parameters such as onset and performance time. RESULTS We included six randomized controlled trials that included 414 patients. Compared with the other BPB group, the CCB group had a significantly lower incidence of HDP (relative ratio: 0.21, 95% CI [0.12, 0.36], P < 0.001) and higher peak expiratory flow rate (mean difference: 0.68 L/s, 95% CI [0.13, 1.23], P = 0.015). There were no significant between-group differences with respect to other adverse events and block performance parameters. CONCLUSIONS Compared with other BPB techniques, CCB involves a lower incidence of HDP with comparable onset and performance time.
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Affiliation(s)
- Chang-Hoon Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Insung Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun-Jung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Hee Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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Yu M, Shalaby M, Luftig J, Cooper M, Farrow R. Ultrasound-Guided Retroclavicular Approach to the Infraclavicular Region (RAPTIR) Brachial Plexus Block for Anterior Shoulder Reduction. J Emerg Med 2022; 63:83-87. [PMID: 35934656 DOI: 10.1016/j.jemermed.2022.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/17/2022] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Shoulder dislocations are a common presenting injury to the emergency department (ED), with anterior dislocations comprising the majority of these cases. Some patients may tolerate gentle manipulation and reduction, but many require analgesia of some type. Oral or parenteral pain medication is often used alone or in combination with procedural sedation if gentle manipulation fails to achieve reduction. Recently, this treatment algorithm has grown to include regional anesthesia as a mode of analgesia for reduction of shoulder dislocations in the form of brachial plexus blocks. It has been well described that the interscalene and supraclavicular approach to the brachial plexus can be used to assist in reduction of anterior shoulder dislocations; however, there has yet to be any published literature regarding the use of ultrasound-guided retroclavicular approach to the infraclavicular region (RAPTIR) brachial plexus blocks for shoulder reduction. CASE REPORT We describe three patients who presented to the ED with anterior shoulder dislocations. The RAPTIR block was performed, provided effective analgesia, and facilitated successful shoulder reduction in all three patients.Why Should an Emergency Physician Be Aware of This? The RAPTIR nerve block is a safe and effective option for analgesia in the patient with an anterior shoulder dislocation. It may have advantages over other brachial nerve blocks and avoids the risks and disadvantages of procedural sedation and opioids.
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Affiliation(s)
- Melissa Yu
- Department of Emergency Medicine, Crozer-Chester Medical Center, Upland, Pennsylvania
| | - Michael Shalaby
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida
| | - Josh Luftig
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, California
| | - Maxwell Cooper
- Department of Emergency Medicine, Crozer-Chester Medical Center, Upland, Pennsylvania
| | - Robert Farrow
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida
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Osterc T, Rupnik B, Rosskopf AB, Borgeat A, Eichenberger U, Aguirre J. Inadvertent Placement of an Infraclavicular Catheter in the Interscalene Region With an Unusual Complication: A Case Report. A A Pract 2022; 16:e01572. [DOI: 10.1213/xaa.0000000000001572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kaye AD, Allampalli V, Fisher P, Kaye AJ, Tran A, Cornett EM, Imani F, Edinoff AN, Djalali Motlagh S, Urman RD. Supraclavicular vs. Infraclavicular Brachial Plexus Nerve Blocks: Clinical, Pharmacological, and Anatomical Considerations. Anesth Pain Med 2021; 11:e120658. [PMID: 35075423 PMCID: PMC8782193 DOI: 10.5812/aapm.120658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022] Open
Abstract
: Peripheral nerve blocks (PNB) have become standard of care for enhanced recovery pathways after surgery. For brachial plexus delivery of anesthesia, both supraclavicular (SC) and infraclavicular (IC) approaches have been shown to require less supplemental anesthesia, are performed more rapidly, have quicker onset time, and have lower rates of complications than other approaches (axillary, interscalene, etc.). Ultrasound-guidance is commonly utilized to improve outcomes, limit the need for deep sedation or general anesthesia, and reduce procedural complications. Given the SC and IC approaches are the most common approaches for brachial plexus blocks, the differences between the two have been critically evaluated in the present manuscript. Various studies have demonstrated slight favorability towards the IC approach from the standpoint of complications and safety. Two prospective RCTs found a higher incidence of complications in the SC approach – particularly Horner syndrome. The IC method appears to support a greater block distribution as well. Overall, both SC and IC brachial plexus nerve block approaches are the most effective and safe approaches, particularly under ultrasound-guidance. Given the success of the supraclavicular and infraclavicular blocks, these techniques are an important skill set for the anesthesiologist for intraoperative anesthesia and postoperative analgesia.
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Affiliation(s)
- Alan D. Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Varsha Allampalli
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Paul Fisher
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Aaron J. Kaye
- Medical University of South Carolina, Department of Anesthesiology and Perioperative Medicine, Charleston, SC, USA
| | - Aaron Tran
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA
| | - Elyse M. Cornett
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amber N. Edinoff
- Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA
- Corresponding Author: Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA, USA.
| | - Soudabeh Djalali Motlagh
- Department of Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Richard D. Urman
- Brigham and Women’s Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston MA, USA
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Dost B, Kaya C, Ustun YB, Turunc E, Baris S. Lateral Sagittal Versus Costoclavicular Approaches for Ultrasound-Guided Infraclavicular Brachial Plexus Block: A Comparison of Block Dynamics Through A Randomized Clinical Trial. Cureus 2021; 13:e14129. [PMID: 33912361 PMCID: PMC8071096 DOI: 10.7759/cureus.14129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction In this study, our objective was to compare the lateral sagittal infraclavicular block (LS-ICB) with the costoclavicular infraclavicular block (CC-ICB) for ultrasound (US)-guided infraclavicular brachial plexus block in terms of block dynamics as well as patient and surgeon satisfaction levels. Methods A total of 100 patients, falling under the American Society of Anaesthesiologists (ASA) I-III categories, who were aged 18-65 years and scheduled for elective forearm and hand surgery were enrolled in the study. The patients were randomly allocated to receive a US-guided LS-ICB or US‑guided CC-ICB. The local anesthetic (LA) agent used (20-ml 0.5% bupivacaine) was identical in all subjects. The block performance time and the motor and sensory block onset times were determined to be the primary outcomes. Results The block performance time and the sensory block onset time were shorter in the CC-ICB group compared to the LS-ICB group [median (interquartile range): three (2.5-3.3) vs. two (1.5-2.3) minutes, p: <0.001; five (4.4-6) vs. four (3.8-6) minutes, p = 0.022, respectively]. The number of needle redirections was lower in the CC-ICB [three (2.7-4) vs. two (one to two) times, p: <0.001]. The motor block onset time and the motor-sensory block times were similar in both groups. There were more patients with a complete sensory blockade at five and 10 minutes in the CC-ICB group than in the LS-ICB group (30% vs. 12%, p = 0.027; 66% vs. 26%, p: <0.001, respectively). No complications were observed with regard to both techniques, and patient and surgeon satisfaction levels observed were similar for both groups. Conclusion Based on our findings, the CC approach provided a shorter performance time and a faster onset of the sensory block compared to the LS approach. However, no complications were reported with respect to either technique, and similar patient and surgeon satisfaction levels were observed.
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Affiliation(s)
- Burhan Dost
- Anesthesiology and Reanimation, Ondokuz Mayis University, Samsun, TUR
| | - Cengiz Kaya
- Anesthesiology and Reanimation, Ondokuz Mayis University, Samsun, TUR
| | - Yasemin B Ustun
- Anesthesiology and Reanimation, Ondokuz Mayis University, Samsun, TUR
| | - Esra Turunc
- Anesthesiology and Reanimation, Ondokuz Mayis University, Samsun, TUR
| | - Sibel Baris
- Anesthesiology and Reanimation, Ondokuz Mayis University, Samsun, TUR
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Beiranvand S, Karimi A, Haghighat Shoar M, Baghizadeh Baghdashti M. The Effects of Magnesium Sulfate with Lidocaine for Infraclavicular Brachial Plexus Block for Upper Extremity Surgeries. J Brachial Plex Peripher Nerve Inj 2020; 15:e33-e39. [PMID: 33173542 PMCID: PMC7647732 DOI: 10.1055/s-0040-1715578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 06/30/2020] [Indexed: 01/01/2023] Open
Abstract
Background An addition of analgesic to anesthetic agents is likely to increase the effects of anesthesia and reduce associated adverse outcomes. Several adjuvants are studied in this regard. The aim of this study is to investigate the effects of adding a magnesium adjunct to lidocaine for the induction of infraclavicular block. Methods Patients referred to Shohada Ashayer Hospital, Khorramabad, for wrist and hand surgery were enrolled in this study. The intervention/case group included patients who received 18 mL lidocaine (2%) + 2 mL magnesium sulfate (50%), 10 mL normal saline; control group: 18 mL lidocaine (2%) + 12 mL of normal saline. After the induction of ultrasound-guided infraclavicular block, parameters such as duration of reach with respect to complete sensory and motor block, hemodynamic parameters (hypotension and bradycardia), and postoperative pain, using visual analogue scale criteria, were measured. The obtained data were analyzed using a Bayesian path analysis model. Results A total of 30 patients were included in each group. In the case group, sensory and motor block was achieved for 12.136 ± 4.96 and 13 ± 3.589 minutes more than those in the control group. The duration of sedation and immobilization was 2.57 ± 0.764 minute and 4.66 ± 0.909 minutes lengthier in the case group. Regarding the hemodynamic parameters, blood pressure was 0.217 ± 5.031 and 1.59 ± 5.14 units lower in the case group, immediately following the block and the surgery. Similarly, heart rate was 0.776 ± 4.548 and 0.39 ± 3.987 units higher in the case group, after 30 minutes and 2 hours of the procedure. A decrease in the pain was seen at 8, 10, and 12 hours after the surgery, as compared with the control group. An addition of magnesium to lidocaine for infraclavicular block resulted in a significantly longer sedation and immobilization period and decreased postoperative pain at 12 hours. Conclusion Heart rate and blood pressure did not decrease significantly in the case group. It can be concluded that addition of magnesium sulfate to lidocaine can produce better anesthetic and analgesic outcomes with low-to-no adverse effects.
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Affiliation(s)
- Siavash Beiranvand
- Department of Anesthesiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Arash Karimi
- Department of Anesthesiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Majid Haghighat Shoar
- Department of Anesthesiology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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