Supraclavicular traction injuries of the brachial plexus.

Thirty supraclavicular traction injuries of the brachial plexus are reported. Young motor cyclists are frequently involved. Recovery is slow and often incomplete. Myelography remains the most useful investigation for prognostic purposes. The management of intractable pain is discussed. An early assessment of prognosis is an important fact in planning and supervising the long-term management of these patients.     

Supraclavicular brachial plexus blocks: review and current practice

This article reviews the possible revival of the supraclavicular brachial plexus blockade due to the use of ultrasound guidance. The brachial plexus is a complex network of nerves, extending from the neck to the axilla, which supplies motor and sensory fibers to the upper extremity. Understanding the complexities of the formation and structure of the brachial plexus remains a cornerstone for effective regional anaesthesia. On the level of the supraclavicular fossa, the plexus is most compactly arranged. The supraclavicular approach of the brachial plexus has a high success rate including blockade of the ulnar and musculocutaneous nerve, which can be missed respectively with the interscalene and axillary approach. However, because of the proximity of the pleura, most anaesthesiologists have been reluctant to perform this supraclavicular approach. The introduction of ultrasound guidance techniques not only reduces the possible risk of pneumothorax but also allows a faster onset time of the block with a reduction of the local anaesthetic dose. This makes the supraclavicular approach a valuable alternative to the axillary, interscalene and infraclavicular approach for upper limb surgery.     

Two approaches to the axillary brachial plexus

A new technique of cannulation of the axillary neurovascular sheath, using loss of resistance to saline, was evaluated and compared to the established technique of eliciting paraesthesiae with a short-bevelled needle. The cannulation technique produced a more reliable block of axillary, musculocutaneous and radial nerves, significantly fewer incomplete blocks and a lower incidence of accidental vessel puncture.     

Ultrasound assisted brachial plexus anesthesia]

Plexus brachialis anaesthesia is a common technique for hand and forearm surgery. If the distance between puncture site and plexus brachialis is to long the anaesthesia will be incomplete. If there happens a direct puncture and injection of anaesthetics in the nerves, neurological deficit can occur. Intravascular injection causes cardial complications. This problems can occur mainly in obese patients in whom the brachial artery cannot be identified well by clinical examination. In these patients we perform the plexus brachialis anaesthesia under sonographical control. For the examination we use a linear 7.5-MHz transducer. The technique is presented.     

Long-term experience with brachial plexus anesthesia

In this work we report on our experience of more than 11 000 cases of plexus anaesthesia in the eight years 1976-1983. Particular care is taken to show how both the increase in experience and the amelioration in technology have led to an increase in the success rate. Our initial and current methods of axillary plexus block are described in detail, as are the most important signs relevant to the placing of the needle. Finally we discuss indications and contraindications, as well as possible complications and their prevention.     

A parascalene technique of brachial plexus anesthesia

A technique for brachial plexus anesthesia is described consisting of the injection of 20 ml of local anesthetic solution into the lower part of the posterior triangle of the neck at a point 1.5 to 2 cm above the clavicle at the lateral border of the anterior scalene muscle. The technique is simple, safe, and produced satisfactory anesthesia of the entire extremity in 97 of the first 100 cases in which it was used. Side effects and complications were minor and transient.