The brachial plexus in the human body originates from the roots of the anterior spinal nerves and consists of formations that are directed to the upper limb. Next, we will talk in detail about the types of blockade of this plexus.
Types of blockade
The following types of blockades are distinguished:
- Interstitial.
- Axillary.
- Supraclavicular.
- Subclavian.
Supraclavicular block: rules of conduct, technique and indications
In the supraclavicular region, the brachial plexus runs between the clavicle and rib, which occurs in the immediate vicinity of the subclavian artery, located behind the anterior scalene muscles. In relation to the artery, the plexus is located laterally. Indications for supraclavicular block of the brachial plexus are as follows:
- During operations in the region of the lower third of the shoulder.
- Against the background of operations on the elbow joints.
- With intervention on the forearm.
- For operations on the brush.
The supraclavicular block of the brachial plexus can be carried out using the search for the nervous structure using paresthesias, by means of a neurostimulator, and also using assisted techniques. To perform supraclavicular blockade using the paresthesia method in the role of plexus verification, the equipment includes:
- A needle for performing manipulations (a blunted needle three centimeters long).
- Connecting tube.
- A pair of syringes with a volume of 20 milliliters for holding the blockade.
- Syringe with a needle for local anesthesia of the skin.
- Sterile balls with napkins.
When using the plexus search technique using a neurostimulator, the set includes a neurostimulator itself, equipped with a surface electrode, and in addition, a special isolated needle with a pointed tip for punctures. As part of the use of assisted technology, a linear sensor for searching for plexuses is also included in the equipment.
Preparations for supraclavicular blockade
Almost any local anesthetic can be used for such a blockage of the brachial plexus. The required volume of anesthetic to complete blockade of the supraclavicular access, as a rule, is 50 milliliters, in accordance with this, the concentration of the drug is calculated taking into account its maximum permissible dose and the presence of vasopressors in the anesthetic solution. According to experts, the addition of adrenaline is desirable, as this allows to improve quality with the duration of the blockade, and in addition, slows down the absorption of local anesthetic.
Complications and preventive measures of supraclavicular blockade
Puncture of the artery may indicate that the needle is moving in front. Manipulation in itself is not dangerous, although a hematoma can form. With puncture arteries, the needle is removed. To ensure hemostasis, use strong pressing in the puncture area for five minutes. After this, attempts to localize the plexuses are repeated, shifting somewhat backward, the needle is inserted in the same direction.
Initial injection of a small amount of solution during intraneural injections allows you to diagnose the location of the needle to prevent possible adverse effects. With the introduction of a large volume of anesthetic, the development of prolonged neuropathies is likely.
Pneumothorax can occur with a frequency of three percent. Provided that the direction of the needle is correctly selected, its appearance is practically eliminated. In cases of its development, a typical clinical picture may appear. To exclude it in doubtful situations, you may need a chest x-ray. Therapy in this case directly depends on the volume, and in addition, on the rate of development of the complication.
What other brachial plexus blockade techniques are known?
Interstitial blockade: rules, techniques and indications
This brachial plexus comes out in people between the middle and front scalene muscles. At this level, the brachial plexus appears in the form of trunks. At the level of the interstitial spaces, the middle and upper roots of the plexus are well accessible, which explains the absence of anesthesia of the ulnar nerves with this type of blockade. The anatomical reference point for needle insertion is the interstitial spaces.
Indications for the implementation of this blockade of the brachial plexus are surgical interventions in the shoulder and shoulder girdle. The absence of an ulnar nerve block allows the use of this technique for intervention on the forearm and hands only in combination with an additional ulnar nerve block.
Interstitial blockade of the brachial plexus is carried out using the search for the nervous structure using paresthesias, neurostimulants, as well as using assisted techniques. To perform interstitial blockade with the use of paresthesia techniques as a plexus verification, the equipment includes:
- A needle for manipulation (a blunt needle up to four centimeters).
- Application of a connecting tube.
- The use of two syringes with a volume of 20 milliliters for holding the blockade.
- The use of a syringe and needle for local anesthesia of the skin.
- The use of napkins.
When using the plexus search technique using a neurostimulator, the kit includes an electrode with a special insulated needle with a short tip for punctures. When using assisted equipment, a linear sensor for searching for plexuses is additionally included in the equipment.
Technique for performing inter-stair blockade
As part of the implementation of the blockade of the brachial plexus with interstitial access, the patient is placed in a position on his back, and his head should be slightly turned in the opposite direction. In this case, the hands are brought to the body and rotate from the outside. Next, the injection sites are processed.
Then determined anatomical landmarks (we are talking about the cricoid cartilage, the lateral edge of the sternum muscle and the interstitial deepening). The projection area of the tubercle is marked. Next, intradermal anesthesia is performed.
Axillary blockade of the brachial plexus: rules, techniques and indications
In the axillary region, the brachial plexus is represented by three bundles, namely the posterior, lateral and medial, they are called because of the axillary artery. All these bundles are located near the axillary artery, which is the main reference point for this blockade. Indications for blockade of the brachial plexus by axillary access are operations on the forearm along with surgical interventions on the hands.
This blockade is carried out using the search for the nervous structure using anatomical landmarks, paresthesia, a neurostimulator, and in addition, using assisted techniques. For subclavian blockade using the anatomical guide or paresthesias as verification of the plexus, equipment, as a rule, includes:
- A needle for manipulation (a blunt needle up to three centimeters).
- Application of a connecting tube.
- The use of two syringes with a volume of 15 milliliters for holding the blockade.
- The use of a syringe and needle for local anesthesia of the skin.
- The use of sterile wipes.
When using the technique of finding the plexus using a neurostimulator, the kit includes a device equipped with a surface electrode along with a special insulated needle up to five centimeters long. When using assisted equipment, a linear sensor is included in the equipment.
Axillary block technique
As part of the axillary blockade of the brachial plexus, the technique includes the following steps:
- The patient fits in a position on his back, his head slightly turns in the opposite direction, and his hand on the side of the intervention takes away ninety degrees and bends at the elbow joint.
- Next, the injection area is treated and its isolation is carried out with sterile linen.
- The axillary artery is palpated, which is done as proximal as possible.
- Local infiltration anesthesia is performed.
- Then the artery is fixed with your fingers.
It is worth saying that the most common transarterial technique along with the technique of perivascular infiltration.
Subclavian block: rules, techniques and indications
Let us consider in more detail the technique of subclavian blockade of the brachial plexus.
At the level of the subclavian fossae, the brachial plexus is immediately represented by three bundles. Plexus bundles can pass in a single fascial vagina along with the subclavian vein and artery. Actually subclavian fossae are delimited: in front they are limited by small and large pectoral muscles, in the middle by ribs, and from above by the coracoid process and clavicle, and in addition, by the humerus. Indications for the blockade, as a rule, are as follows:
- Carrying out operations on the elbow joint.
- Performing operations on the forearm.
- Carrying out operations on the hands.
Subclavian blockade can be performed using the search for the nervous structure using paresthesia and assisted techniques. To carry out such a blockade, equipment includes:
- A needle for performing manipulations (a blunt needle ten centimeters long).
- Connecting tube.
- Two syringes with a volume of 20 milliliters to complete the blockade.
- A needle and syringe to perform local anesthesia of the skin.
Subclavian blockade technique
The technique for performing this type of blockade includes the following techniques:
- The patient is placed in a position on his back, the patient’s head slightly turns in the opposite direction, and his hand on the side of the intervention deflects and bends at the elbow joint ninety degrees.
- The injection site is being treated along with isolation with sterile underwear.
- Next, an anatomical landmark is determined.
- The needle entry point is two centimeters medial and as much caudal than the lateral edges of the coracoid process.
The article examined the basic techniques of brachial plexus blockade.