From the Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Nova Scotia Health Authority and IWK Health Centre, Halifax, Nova Scotia, Canada.
Reg Anesth Pain Med. 2018 Oct;43(7):752-755. doi: 10.1097/AAP.0000000000000826.
Retroclavicular block is designed to overcome the negative aspects of the commonly utilized ultrasound-guided parasagittal approach to the infraclavicular block. However, this approach necessitates the needle traversing an area posterior to the clavicle inaccessible to ultrasound wave conduction. This study sought to document the structures vulnerable to needle injury during a retroclavicular block.
A Tuohy needle was inserted using a retroclavicular approach to the infraclavicular block in 3 lightly embalmed cadavers followed by a catheter insertion 4 cm beyond the needle tip. The process was repeated on the contralateral side. With the needle and catheter in position, the cadavers were dissected and photographed.
In 4 of the 6 dissections, the needle was directly touching the suprascapular nerve deep to the clavicle. In the remaining 2 dissections, the suprascapular nerve was within 2 cm of the needle. In 1 dissection, the suprascapular vein was indented, behind the clavicle. The trapezius was the only muscle layer traversed by the needle in all dissections. In 3 of the 6 dissections, the catheter penetrated the posterior cord. In the remaining 3, the catheter threaded along the neurovascular bundle.
The suprascapular nerve is consistently in the path of the block needle posterior to the clavicle. This raises the possibility of risk of injury to the suprascapular nerve when using this approach to the brachial plexus. Vascular injury is also possible deep to the clavicle, and because of the noncompressible location, caution is advised in patients with disordered coagulation.
锁骨后阻滞旨在克服常用的超声引导锁骨下入路锁骨下阻滞的负面问题。然而，这种方法需要使针尖穿过锁骨后超声无法到达的区域。本研究旨在记录锁骨后阻滞时针头可能损伤的结构。
在 3 具轻度防腐的尸体上，使用锁骨后入路进行锁骨下入路阻滞，然后将导管插入针尖外 4 cm 处。在对侧重复该过程。当针和导管就位后，对尸体进行解剖和拍照。
在 6 次解剖中有 4 次，针直接触及锁骨下的肩胛上神经。在其余 2 次解剖中，肩胛上神经距离针 2 cm 以内。在 1 次解剖中，锁骨后面的肩胛上静脉被压痕。在所有的解剖中，只有斜方肌被针穿过。在 6 次解剖中有 3 次，导管穿透了后索。在其余 3 次中，导管沿着神经血管束穿过。
在锁骨后，肩胛上神经始终处于阻滞针的路径上。这增加了使用这种方法进行臂丛阻滞时损伤肩胛上神经的可能性。在锁骨后面也可能发生血管损伤，由于位置不可压缩，建议在凝血功能障碍的患者中谨慎使用。
