Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada.
Can J Anaesth. 2021 Aug;68(8):1156-1164. doi: 10.1007/s12630-021-01990-8. Epub 2021 Apr 21.
The costoclavicular block is a relatively novel alternative to the infraclavicular block. We aimed to determine the anatomical structures vulnerable to needle injury during a costoclavicular block.
The needle path consistent with a costoclavicular block approach was performed bilaterally on four lightly embalmed cadavers using ultrasound guidance. Careful dissection was performed with 18-G Tuohy needles in situ and photographs were taken.
The needle penetrated the deltoid in six of eight cases and the pectoralis minor in three of eight cases. The subclavius tendon or its fascia were punctured in two of eight cases. The lateral cord was in contact with the needle in six procedures and punctured in three. The posterior cord was contacted in two instances, and the medial cord in one. In a single dissection, the needle was in contact with the medial antebrachial cutaneous nerve. The needle was close to the medial brachial cutaneous nerve in one case and close to the pectoral nerves in two of eight cases. While the cephalic vein and thoracoacromial artery were consistently nearby, there were no cases of vascular puncture.
We found that the needle path may be close to the medial antebrachial cutaneous nerve, medial brachial cutaneous nerve, and pectoral nerves but did not traverse any critical structures aside from the lateral cord. This suggests relative safety when compared with other approaches to the infraclavicular brachial plexus. Structures dans la trajectoire de l'aiguille du bloc de plexus brachial costoclaviculaire : une étude cadavérique.
锁骨下径路阻滞是一种相对新颖的替代锁骨下阻滞的方法。我们旨在确定锁骨下径路阻滞时针头易损伤的解剖结构。
在 4 具轻度防腐的尸体上，使用超声引导双侧进行与锁骨下径路阻滞一致的针道。在原位使用 18-G Tuohy 针进行仔细解剖，并拍摄照片。
8 例中有 6 例针穿透三角肌，8 例中有 3 例穿透胸小肌。2 例中有 8 例的锁骨下肌肌腱或其筋膜被刺穿。6 例中外侧束与针接触，3 例中被刺穿。2 例后束接触，1 例内侧束接触。在一次解剖中，针与前臂内侧皮神经接触。1 例中针靠近内侧臂皮神经，8 例中有 2 例靠近胸神经。虽然头静脉和肩胸动脉始终在附近，但没有血管穿刺的病例。
我们发现针道可能靠近前臂内侧皮神经、臂内侧皮神经和胸神经，但除了外侧束外，没有穿过任何关键结构。与其他锁骨下臂丛神经阻滞方法相比，这表明相对安全。
