Document Detail


Case report: limitation of local anesthetic spread during ultrasound-guided interscalene block. Description of an anatomic variant with clinical correlation.
MedLine Citation:
PMID:  18675748     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The use of ultrasound (US) for localization of neural structures allows real-time visualization of anatomy; however, variability in the arrangement of structures has been observed. The impact of these variations on the performance and outcome of regional anesthetic techniques remains unclear. We discuss possible anatomic explanations and correlation with clinical observations. CASE REPORT: We report limited spread of local anesthetic observed during the performance of a US-guided interscalene block. This was associated with an anomalous vessel arising from the subclavian artery, which effectively divided the brachial plexus into 2 compartments. Spread of local anesthetic was restricted to the upper compartment around the C5 through C7 nerve roots. There was no anesthetic fluid visualized in the lower compartment. This produced a block that provided surgical anesthesia for shoulder arthroscopy as well as excellent postoperative analgesia, although the medial and distal aspects of the arm remained unaffected. CONCLUSIONS: This case illustrates the ability of US to identify anatomic variations and their relevance to the performance of regional anesthetic techniques.
Authors:
Matthew S Abrahams; Oliver Panzer; Arthur Atchabahian; Jean-Louis Horn; Anthony R Brown
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Regional anesthesia and pain medicine     Volume:  33     ISSN:  1532-8651     ISO Abbreviation:  Reg Anesth Pain Med     Publication Date:    2008 Jul-Aug
Date Detail:
Created Date:  2008-08-04     Completed Date:  2008-10-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9804508     Medline TA:  Reg Anesth Pain Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  357-9     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR 97239-3011, USA. abrahama@ohsu.edu
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MeSH Terms
Descriptor/Qualifier:
Anesthetics, Local / pharmacokinetics*
Brachial Plexus / anatomy & histology*,  ultrasonography*
Humans
Male
Middle Aged
Nerve Block / methods*
Shoulder / surgery*
Chemical
Reg. No./Substance:
0/Anesthetics, Local

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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