scholarly journals Brachial Plexus Anatomy: Normal and Variant

2009 ◽  
Vol 9 ◽  
pp. 300-312 ◽  
Author(s):  
Steven L. Orebaugh ◽  
Brian A. Williams
Keyword(s):  
Brachial Plexus ◽  
Relevant Literature ◽  
Axillary Nerve ◽  
Cochrane Library ◽  
Anatomic Variations ◽  
Normal Anatomy ◽  
Nerve Blocks ◽  
Mesh Terms ◽  
Brachial Plexus Blockade ◽  
Real Time Ultrasonography

Effective brachial plexus blockade requires a thorough understanding of the anatomy of the plexus, as well as an appreciation of anatomic variations that may occur. This review summarizes relevant anatomy of the plexus, along with variations and anomalies that may affect nerve blocks conducted at these levels. The Medline, Cochrane Library, and PubMed electronic databases were searched in order to compile reports related to the anatomy of the brachial plexus using the following free terms: "brachial plexus", "median nerve", "ulnar nerve", "radial nerve", "axillary nerve", and "musculocutanous nerve". Each of these was then paired with the MESH terms "anatomy", "nerve block", "anomaly", "variation", and "ultrasound". Resulting articles were hand searched for additional relevant literature. A total of 68 searches were conducted, with a total of 377 possible articles for inclusion. Of these, 57 were found to provide substantive information for this review. The normal anatomy of the brachial plexus is briefly reviewed, with an emphasis on those features revealed by use of imaging technologies. Anomalies of the anatomy that might affect the conduct of the various brachial plexus blocks are noted. Brachial plexus blockade has been effectively utilized as a component of anesthesia for upper extremity surgery for a century. Over that period, our understanding of anatomy and its variations has improved significantly. The ability to explore anatomy at the bedside, with real-time ultrasonography, has improved our appreciation of brachial plexus anatomy as well.

scholarly journals Effective Volume of Ropivacaine 0.75% through a Catheter Required for Interscalene Brachial Plexus Blockade

2013 ◽  
Vol 118 (4) ◽  
pp. 863-867 ◽  
Author(s):  
Catherine Vandepitte ◽  
Philippe Gautier ◽  
Daquan Xu ◽  
Emine A. Salviz ◽  
Admir Hadzic
Keyword(s):  
Brachial Plexus ◽  
Success Rate ◽  
Onset Time ◽  
Sensory Block ◽  
Effective Volume ◽  
Nerve Blocks ◽  
Injection Volume ◽  
Institutional Ethics ◽  
Brachial Plexus Blockade ◽  
Arthroscopic Shoulder Surgery

Abstract Background: Ultrasound guidance during peripheral nerve blocks has allowed for reduction in dose and volume of local anesthetic required to accomplish successful blockade using multiple injections through a needle. The authors undertook this study to determine the minimal effective volume required to accomplish successful interscalene brachial plexus block (ISB) through the catheter. Methods: After obtaining institutional ethics committee approval and written informed consent, patients aged 18–75 yr and scheduled for arthroscopic shoulder surgery under ISB were enrolled. All patients using a step-up/step-down method and the starting dose of 15 ml of 0.75% ropivacaine received an ultrasound-guided ISB catheter. The injection volume was increased or decreased by 1 ml in case of block failure or block success, respectively. Results: The authors found that the proportion of patients with successful blockade increased sharply from approximately 57% at 6 ml to 100% by 7 ml, indicating that a small increase in volume of ropivacaine 0.75% markedly affects the success rate. A total of 12 ISB with injection volume less than 7 ml resulted in successful anesthesia within 30 min, yielding an ED95 of 7 ml (95% CI 6.8–7.2) ropivacaine 0.75%. For the group as a whole, the median (min–max) sensory block onset time was 5 (5–20) min, the median (min–max) motor blocks for the biceps and the deltoid muscles were 7.5 (5–15) min and 10 (5–15) min, respectively. The median (min–max) block duration was 8.9 (3–15) h. Conclusions: An injection of a minimum of 7 ml of ropivacaine 0.75% through the catheter is required for success rate and timely onset of surgical anesthesia with ISB.

scholarly journals Brachial Plexus Blockade Causes Subclinical Neuropathy

Hand ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 50-54 ◽  
Author(s):  
Donato J. Perretta ◽  
Matthew Gotlin ◽  
Kenneth Brock ◽  
Nader Paksima ◽  
Michael B. Gottschalk ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Statistical Significance ◽  
Hand Surgery ◽  
Block Group ◽  
Short Term ◽  
Nerve Blocks ◽  
Subclinical Neuropathy ◽  
Brachial Plexus Blockade ◽  
Group A

Background: The objective of this study is to determine subclinical changes in hand sensation after brachial plexus blocks used for hand surgery procedures. We used Semmes-Weinstein monofilament testing to detect these changes. We hypothesized that patients undergoing brachial plexus nerve blocks would have postoperative subclinical neuropathy detected by monofilament testing when compared with controls. Methods: In total, 115 hand surgery adult patients were prospectively enrolled in this study. All patients undergoing nerve-related procedures were excluded as well as any patients with preoperative clinically apparent nerve deficits. Eighty-four patients underwent brachial plexus blockade preoperatively, and 31 patients underwent general anesthesia (GA). Semmes-Weinstein monofilament testing of the hand was performed preoperatively on both the operative and nonoperative extremities and postoperatively at a mean of 11 days on both hands. Preoperative and postoperative monofilament testing scores were compared between the block hand and the nonoperated hand of the same patient, as well as between the block hands and the GA-operated hands. Results: There were no recorded clinically relevant neurologic complications in the block group or GA group. A statistically significant decrease in sensation in postoperative testing in the operated block hand compared with the nonoperated hand was noted. When comparing the operated block hand with the operated GA hand, there was a decrease in postoperative sensation in the operated block hand that did not reach statistical significance. Conclusions: Brachial plexus blockade causes subtle subclinical decreases in sensibility at short-term follow-up, without any clinically relevant manifestations.

Brachial Plexus Variations in Human Fetuses

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 676-684 ◽  
Author(s):  
İsmihan İlknur Uysal ◽  
Muzaffer Şeker ◽  
Ahmet Kağan Karabulut ◽  
Mustafa Büyükmumcu ◽  
Taner Ziylan
Keyword(s):  
Brachial Plexus ◽  
Median Nerve ◽  
Surgical Procedures ◽  
Distal Part ◽  
Axillary Nerve ◽  
Human Fetuses ◽  
Anatomic Variations ◽  
Normal Position ◽  
Morphological Variations ◽  
Posterior Division

Abstract OBJECTIVE We examined the anatomic variations of the brachial plexus (BP) in human fetuses. METHODS This study was performed with 200 BPs from spontaneously aborted fetuses without detectable malformations. The plexuses were dissected, and the normal position and/or morphological variations of the BP were determined and photographed. RESULTS There were no variations in 93 plexuses, and 107 plexuses were observed to have different variations. Morphological variations were observed more frequently among female fetuses and right sides. The BPs were composed mostly of the C5, C6, C7, and C8 nerves and the T1 nerve (71.5%). A prefixed plexus was observed in 25.5% of cases, and a postfixed plexus was observed in 2.5% of cases. In one case (0.5%), the C4 and T2 nerves joined the formation. The inferior trunk was not formed in 9% of cases. The superior trunk was not formed in 1% of cases. In one plexus, the superior trunk was formed by the ventral rami of the C4 and C5 nerves. In one case, the inferior trunk was formed by the ventral rami of the T1 and T2 nerves. Division variations were observed most frequently. There were also variations in the terminal branches, such as the roots of the median nerve joining in the distal part of the arm (8.5%), the axillary nerve being separate from the posterior division of the superior trunk (2.5%), and a connection existing between the median and musculocutaneous nerves (1%). CONCLUSION Knowledge of BP variations is important for surgeons who perform surgical procedures in the cervical and axillary regions.

scholarly journals Analysis of Patient-Dependent and Trauma-Dependent Risk Factors for Persistent Brachial Plexus Injury after Shoulder Dislocation

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Olga Gutkowska ◽  
Jacek Martynkiewicz ◽  
Marek Stępniewski ◽  
Jerzy Gosk
Keyword(s):  
Risk Factors ◽  
Brachial Plexus ◽  
Shoulder Dislocation ◽  
Relevant Literature ◽  
Axillary Nerve ◽  
Operative Intervention ◽  
Time Interval ◽  
Nerve Injuries ◽  
Accompanying Injuries ◽  
Single Nerve

Brachial plexus injuries (BPIs) caused by shoulder dislocation usually have a transient character and tend to resolve spontaneously. However, in some patients the symptoms can persist and require operative intervention. This work aims to determine the risk factors for persistent BPIs resulting from shoulder dislocation. The study comprised 73 patients (58 men, 15 women; mean age: 50 years) treated operatively between the years 2000 and 2016 for persistent BPIs resulting from shoulder dislocation. Patient age, gender, type of initial trauma, number of affected nerves, presence of accompanying injuries, and time interval from dislocation to its reduction were analysed. Elderly patients more often sustained multiple-nerve injuries, while single nerve injuries were more often observed in younger patients. Injury to a single nerve was diagnosed in 30% of the patients. Axillary nerve was most commonly affected. Fracture of the greater tuberosity of humerus coincided with total BPI in 50% of the cases. Longer unreduced period caused injury to multiple nerves. Analysis of our patient group against relevant literature revealed that persistent BPI after shoulder dislocation is more common in older patients. Injuries to ulnar and median nerves more often require operative intervention due to low potential for spontaneous recovery of these nerves.

scholarly journals The Shoulder Block: A New Alternative to Interscalene Brachial Plexus Blockade for the Control of Postoperative Shoulder Pain

2007 ◽  
Vol 35 (4) ◽  
pp. 575-581 ◽  
Author(s):  
D.J. Price
Keyword(s):  
Postoperative Pain ◽  
Brachial Plexus ◽  
Shoulder Joint ◽  
Suprascapular Nerve ◽  
Axillary Nerve ◽  
Posterior Surface ◽  
Selective Blockade ◽  
Brachial Plexus Blockade ◽  
Axillary Nerve Block ◽  
Postoperative Shoulder

This report describes the development of the shoulder block, an alternative to interscalene brachial plexus blockade for the control of postoperative pain following shoulder surgery. Included is a review of the relevant anatomy of the shoulder joint and its associated structures. Two nerves provide the bulk of the innervation to this area: the suprascapular nerve and the axillary (circumflex) nerve. The shoulder block technique involves selective blockade of both of these nerves instead of general blockade of the entire brachial plexus via the interscalene route. The technique of Meier is used to block the suprascapular nerve in the supraspinous fossa. No descriptions of axillary nerve block were available in the literature, so a technique for blocking this nerve as it travels across the posterior surface of the humerus was developed and is described, along with a discussion of the author's initial clinical experience.

Distal Peripheral Nerve Blocks in the Forearm as an Alternative to Proximal Brachial Plexus Blockade in Patients Undergoing Hand Surgery: A Prospective and Randomized Pilot Study

2016 ◽  
Vol 41 (10) ◽  
pp. 969-977 ◽  
Author(s):  
José R. Soberón ◽  
Joseph W. Crookshank ◽  
Bobby D. Nossaman ◽  
Clint E. Elliott ◽  
Leslie E. Sisco-Wise ◽  
...  
Keyword(s):  
Pilot Study ◽  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Hand Surgery ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Brachial Plexus Blockade

Characteristics of the Frequency-Following Response to Speech in Neonates and Potential Applicability in Clinical Practice: A Systematic Review

2020 ◽  
Vol 63 (5) ◽  
pp. 1618-1635
Author(s):  
Céline Richard ◽  
Mary Lauren Neel ◽  
Arnaud Jeanvoine ◽  
Sharon Mc Connell ◽  
Alison Gehred ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cochrane Library ◽  
Neurodevelopmental Outcomes ◽  
Frequency Following Response ◽  
Ovid Medline ◽  
Published Evidence ◽  
Mesh Terms ◽  
Potential Applicability ◽  
Clinical Potential

Purpose We sought to critically analyze and evaluate published evidence regarding feasibility and clinical potential for predicting neurodevelopmental outcomes of the frequency-following responses (FFRs) to speech recordings in neonates (birth to 28 days). Method A systematic search of MeSH terms in the Cumulative Index to Nursing and Allied HealthLiterature, Embase, Google Scholar, Ovid Medline (R) and E-Pub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Web of Science, SCOPUS, COCHRANE Library, and ClinicalTrials.gov was performed. Manual review of all items identified in the search was performed by two independent reviewers. Articles were evaluated based on the level of methodological quality and evidence according to the RTI item bank. Results Seven articles met inclusion criteria. None of the included studies reported neurodevelopmental outcomes past 3 months of age. Quality of the evidence ranged from moderate to high. Protocol variations were frequent. Conclusions Based on this systematic review, the FFR to speech can capture both temporal and spectral acoustic features in neonates. It can accurately be recorded in a fast and easy manner at the infant's bedside. However, at this time, further studies are needed to identify and validate which FFR features could be incorporated as an addition to standard evaluation of infant sound processing evaluation in subcortico-cortical networks. This review identifies the need for further research focused on identifying specific features of the neonatal FFRs, those with predictive value for early childhood outcomes to help guide targeted early speech and hearing interventions.

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