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Showing 2 results for Brachial Plexus
Ultrasound-guided brachial plexus block: a study on 30 patients
Amiri Hr, Makarem J,
Volume 67, Issue 2 (5-2009)
Abstract

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Successful brachial plexus blocks rely on proper techniques of nerve localization, needle placement, and local anesthetic injection. Standard approaches used today (elicitation of paresthesia or nerve-stimulated muscle contraction), unfortunately, are all "blind" techniques resulting in procedure-related pain and complications. Ultrasound guidance for brachial plexus blocks can potentially improve success and complication rates. This study presents the ultrasound-guided brachial plexus blocks for the first time in Iran in adults and pediatrics.
Methods: In this study ultrasound-guided brachial plexus blocks in 30 patients (25 adults & 5 pediatrics) scheduled for an elective upper extremity surgery, are introduced. Ultrasound imaging was used to identify the brachial plexus before the block, guide the block needle to reach target nerves, and visualize the pattern of local anesthetic spread. Needle position was further confirmed by nerve stimulation before injection. Besides basic variables, block approach, block time, postoperative analgesia duration (VAS<3 was considered as target pain control) opioid consumption during surgery, patient satisfaction and block related complications were reported.
Results: Mean adult age was 35.5±15 and in pediatric group was 5.2±4. Frequency of interscalene, supraclavicular, axillary approaches to brachial plexus in adults was 5, 7, 13 respectively. In pediatrics, only supraclavicular approach was accomplished. Mean postoperative analgesia time in adults was 8.5±4 and in pediatrics was 10.8±2. No block related complication were observed and no supplementary, were needed.

Conclusions: Real-time ultrasound imaging during brachial plexus blocks can facilitate nerve localization and needle placement and examine the pattern and extend of local anesthetic spread.


Variation in median nerve nutritional artery at the distal end of forearm: case report
Fakhroddin Aghajanpour, Reza Soltani, Azar Afshar, Hojjat Allah Abbaszadeh, Reza Mastery Farahani, Mohsen Nourozian,
Volume 79, Issue 4 (7-2021)
Abstract
Background: The median nerve is one of the most important branches of the brachial plexus. Due to the role of the median nerve in sensory and motor innervation of the forearm and hand in the upper limbs, its blood supply is very important. Awareness of variations in the blood supply pattern to this nerve reduces the incidence of necrosis and ischemia of the nerve during surgical and diagnostic procedures.
Case Presentation: During routine dissection of the cadaver of a 65-year-old man fixed in formalin (10%), in the Department of Anatomy and Reproductive Biology, Shahid Beheshti University of Medical Sciences, a rare variation was observed in the median nerve nutritional artery at the distal end of the left forearm. After dissection of the skin, superficial and deep fascia, anterior compartment forearm muscles, nerves and blood vessels were exposed from surrounding tissues. The median nerve passed through the two heads of the pronator teres muscle and left the cubital fossa in the depth of the flexor digitorum superficialis and the surface of the flexor digitorum profundus in the forearm. It was observed that at the distal end of the left forearm between the flexor carpi radialis and the flexor digitorum superficialis, a relatively thick branch originates from the radial artery and supplies blood to the median nerve. This branch was separated from the radial artery (before the artery enters the anatomical snuffbox) and crossed the surface of the flexor carpi radialis muscle and inserted into the median nerve sheath. In the forearm, this branch was the only artery supplying blood to the median nerve.
Conclusion: Due to the superficial position of the median nerve at the distal end of the forearm, physical damage to the nerve and its nutritional artery leads to necrosis and ischemia of the nerve, and ultimately disturbed the transmission of sensory and motor messages.

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