Brachial Plexus Block Clinical Trial
Official title:
Clinical And Anatomic Study Of An Ultrasound-Guided Selective Block Of The Superior Trunk Of The Brachial Plexus. Description Of A New Approach
Introduction
Interscalene brachial plexus block is the most commonly performed regional anesthesia
technique to promote analgesia for shoulder surgeries. However, one of limitations is the
risk of phrenic nerve palsy despite injection of low volumes, being contraindicated in
patients with limited pulmonary reserve.
Burckett-St.Laurent et al described an alternative approach to avoid phrenic block - the
superior trunk approach.
In this case series, the investigators suggest a modification of Burckett-St.Laurent`s
technique. The objective of this study is to evaluate efficacy, phrenic nerve function and
contrast dispersion in cadavers after performing this new approach.
Materials and methods
The study was approved by Institutional Review Board of our institution. To perform the
superior trunk approach described by Burckett-St.Laurent, C5 and C6 nerve roots are
identified within the interscalene groove and traced distally to where they coalesce into the
superior trunk, proximal to the takeoff of the suprascapular nerve. Burckett-St.Laurent et al
suggest spreading local anesthetic around superior trunk at this point.
The investigators suggest an injection more distally, where superior trunk is in
costoclavicular space below omohyoid muscle, proximal to the suprascapular outlet. The needle
is advanced below the prevertebral layer of deep cervical fascia, avoiding that the tip of
the needle lies in the fascial plane between investing layer of deep vertebral fascia and
prevertebral layer, a loose fascial plane where lymph node chain is located and may allow
postero-anterior dispersion toward phrenic. To guarentee right position of the tip the
investigators suggest an intracluster pattern of spread.
Patients scheduled for rotator cuff surgery will receive 6 mL of 0,5% bupivacaine in this new
approach. Successful block is defined as motor score of ≤ 2 on modified Bromage scale in the
deltoid and bíceps; absent sensation to cold and pinprick sensation in C5 and C6 dermatomes
within 30 minutes of injection.
To evaluate phrenic nerve, diaphragmatic excursion will be assessed by ultrasonography of
ipsilateral hemidiaphragm and impedance tomography. Pain scores and analgesic consumption
will be assessed in PACU.
Moreover, 6 mL of methylene blue will be injected into cadavers to evaluate if dispersion is
restricted to fibers of the superior trunk and don`t reach phrenic nerve.
n/a
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|---|---|---|---|
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