Anesthesia and Pain Management, Toronto Western Hospital, University Health Netwrok, Toronto, Ontario, Canada.
Anesthesia and Pain Management, Toronto Western Hospital, University Health Netwrok, Toronto, Ontario, Canada
Reg Anesth Pain Med. 2020 May;45(5):377-380. doi: 10.1136/rapm-2019-101260. Epub 2020 Mar 11.
We propose a new approach to local anesthetic injection for the supraclavicular brachial plexus block: an intertruncal approach by which local anesthetic is deposited in the two adipose tissue planes between the upper and middle and the middle and lower trunks. We present sonographic and microscopic images to illustrate the relevant anatomy. This approach offers potential advantages over the 'corner pocket' technique in that it results in consistent local anesthetic spread to the three plexus trunks and the needle endpoint lies farther away from the pleural surface which is important for the prevention of pneumothorax. It also offers an advantage over the 'intracluster' approach as it purposefully avoids intraneural injection respecting the integrity of the epineurium of individual trunks. Comparative studies are required to confirm that these anatomic and technical advantages result in improved outcomes.
一种通过在中上干和中、下干之间的两个脂肪组织平面内注入局部麻醉剂的干间入路。我们呈现超声和显微镜图像来阐明相关解剖结构。与“角袋”技术相比，这种方法具有潜在的优势，因为它能使局部麻醉剂均匀地扩散到三个丛干，并使针头的终点远离胸膜表面，这对于预防气胸很重要。与“神经丛内”入路相比，它也具有优势，因为它故意避免在神经内注射，从而尊重各个干的神经外膜的完整性。需要进行比较研究来证实这些解剖和技术优势是否能带来更好的结果。
