Articles de revues : « Plexus blockade »

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Baxter, A. G., et D. M. Coventry. « Brachial plexus blockade ». Current Anaesthesia & ; Critical Care 10, n^o 3 (juin 1999) : 164–69. http://dx.doi.org/10.1016/s0953-7112(99)80009-x.

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Al‐Haddad, MF, et DM Coventry. « Brachial plexus blockade ». BJA CEPD Reviews 2, n^o 2 (avril 2002) : 33–36. http://dx.doi.org/10.1093/bjacepd/2.2.33.

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Schultz, David M. « Inferior Hypogastric Plexus Blockade : A Transsacral Approach ». November 2007 6;10, n^o 6;11 (14 novembre 2007) : 757–63. http://dx.doi.org/10.36076/ppj.2007/10/757.

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Background: Despite recent refinements in the technique of hypogastric plexus blockade, the lower pelvic organs and genitalia are innervated by fibers from the pre-sacral inferior hypogastric plexus and these fibers are not readily blocked using paravertebral or transdiscal approaches. Design: Report of a technique to introduce a transsacral approach to blockade of the inferior hypogastric plexus. Methods: A technique for performing inferior hypogastric plexus blockade by passing a spinal needle through the sacral foramen is described with 15 blocks in 11 patients. Results: Fifteen inferior hypogastric plexus blocks were performed on 11 female patients who presented with chronic pelvic pain. Pelvic pain was decreased following 11 of the procedures with pre- and post-pain scores (SD) of 7.4 (2.3) and 5.0 (2.7), respectively (P < 0.05). There were no complications or unusual occurrences. Conclusions: This block can be performed safely and effectively if the interventionalist has a high degree of familiarity with sacral anatomy, refined needle steering technique, and expertise in fluoroscopy. Properly performed, transsacral blockade of the inferior hypogastric plexus is a safe technique for the diagnosis and treatment of chronic pain conditions involving the lower pelvic viscera. Key words: Pelvic pain, chronic pain, inferior hypogastric plexus block, superior hypogastric plexus, transsacral approach.

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Bollini, Carlos A. « Interscalene brachial plexus blockade ». Techniques in Regional Anesthesia and Pain Management 10, n^o 3 (juillet 2006) : 89–94. http://dx.doi.org/10.1053/j.trap.2006.07.008.

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Schupfer, Guido K., et Martin Johr. « Infraclavicular Vertical Plexus Blockade ». Anesthesia & ; Analgesia 84, n^o 1 (janvier 1997) : 233. http://dx.doi.org/10.1097/00000539-199701000-00058.

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Kubota, Y., T. Okamoto et Y. Ueda. « Continuous brachial plexus blockade ». Anaesthesia 45, n^o 6 (juin 1990) : 497. http://dx.doi.org/10.1111/j.1365-2044.1990.tb14359.x.

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Sarma, V. J. « Continuous brachial plexus blockade ». Anaesthesia 45, n^o 8 (août 1990) : 695. http://dx.doi.org/10.1111/j.1365-2044.1990.tb14421.x.

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Chin, Ki Jinn, Anahi Perlas, Vincent Chan et Richard Brull. « Continuous Infraclavicular Plexus Blockade ». Anesthesia & ; Analgesia 109, n^o 4 (octobre 2009) : 1347–48. http://dx.doi.org/10.1213/ane.0b013e3181b10103.

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Schupfer, Guido K., et Martin Johr. « Infraclavicular Vertical Plexus Blockade ». Anesthesia & ; Analgesia 84, n^o 1 (janvier 1997) : 233. http://dx.doi.org/10.1213/00000539-199701000-00058.

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Geiger, P., et H. H. Mehrkens. « Vertical infraclavicular brachial plexus blockade ». Techniques in Regional Anesthesia and Pain Management 7, n^o 2 (avril 2003) : 67–71. http://dx.doi.org/10.1053/trap.2003.000119.

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Neuburger, M., H. Kaiser, I. Rembold-Schuster et H. Landes. « Vertikale infraklavikuläre Plexus-brachialis-Blockade ». Der Anaesthesist 47, n^o 7 (29 juillet 1998) : 595–99. http://dx.doi.org/10.1007/s001010050601.

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McGlade, D. P. « Extensive Central Neural Blockade following Interscalene Brachial Plexus Blockade ». Anaesthesia and Intensive Care 20, n^o 4 (novembre 1992) : 514–16. http://dx.doi.org/10.1177/0310057x9202000424.

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Satapathy, Ashish R., et David M. Coventry. « Axillary Brachial Plexus Block ». Anesthesiology Research and Practice 2011 (2011) : 1–5. http://dx.doi.org/10.1155/2011/173796.

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The axillary approach to brachial plexus blockade provides satisfactory anaesthesia for elbow, forearm, and hand surgery and also provides reliable cutaneous anaesthesia of the inner upper arm including the medial cutaneous nerve of arm and intercostobrachial nerve, areas often missed with other approaches. In addition, the axillary approach remains the safest of the four main options, as it does not risk blockade of the phrenic nerve, nor does it have the potential to cause pneumothorax, making it an ideal option for day case surgery. Historically, single-injection techniques have not provided reliable blockade in the musculocutaneous and radial nerve territories, but success rates have greatly improved with multiple-injection techniques whether using nerve stimulation or ultrasound guidance. Complete, reliable, rapid, and safe blockade of the arm is now achievable, and the paper summarizes the current position with particular reference to ultrasound guidance.

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Perretta, Donato J., Matthew Gotlin, Kenneth Brock, Nader Paksima, Michael B. Gottschalk, Germaine Cuff, Michael Rettig et Arthur Atchabahian. « Brachial Plexus Blockade Causes Subclinical Neuropathy ». HAND 12, n^o 1 (8 juillet 2016) : 50–54. http://dx.doi.org/10.1177/1558944716650411.

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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.

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STAFFORD, B. « More complications of coeliac plexus blockade ». Australian and New Zealand Journal of Medicine 21, n^o 5 (octobre 1991) : 782–83. http://dx.doi.org/10.1111/j.1445-5994.1991.tb01394.x.

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Klein, Stephen M., et Chester C. Buckenmaier. « Ambulatory continuous interscalene brachial plexus blockade ». Techniques in Regional Anesthesia and Pain Management 8, n^o 2 (avril 2004) : 58–62. http://dx.doi.org/10.1053/j.trap.2004.02.001.

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Cornish, Philip B. « Applied Anatomy of Cervical Plexus Blockade ». Anesthesiology 90, n^o 6 (1 juin 1999) : 1790–91. http://dx.doi.org/10.1097/00000542-199906000-00047.

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Stoneham, Mark. « Applied Anatomy of Cervical Plexus Blockade ». Anesthesiology 90, n^o 6 (juin 1999) : 1791. http://dx.doi.org/10.1097/00000542-199906000-00048.

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Orebaugh, Steven L., et Paul Bigeleisen. « Ultrasound imaging in brachial plexus blockade ». Seminars in Anesthesia, Perioperative Medicine and Pain 26, n^o 4 (décembre 2007) : 180–88. http://dx.doi.org/10.1053/j.sane.2007.10.002.

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Okasha, A. S., A. M. El-Attar et H. L. Soliman. « Enhanced brachial plexus blockade. Effect of pain and muscular exercises on the efficiency of brachial plexus blockade ». Anaesthesia 43, n^o 4 (22 février 2007) : 327–29. http://dx.doi.org/10.1111/j.1365-2044.1988.tb08987.x.

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Yalcin, Saban, Hasan Cece, Halil Nacar et MahmutAlp Karahan. « Axillary brachial plexus blockade in moyamoya disease ? » Indian Journal of Anaesthesia 55, n^o 2 (2011) : 160. http://dx.doi.org/10.4103/0019-5049.79897.

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COLEMAN, M. « Pectorialis major in interscalene brachial plexus blockade ». Regional Anesthesia and Pain Medicine 24, n^o 2 (mars 1999) : 190–91. http://dx.doi.org/10.1016/s1098-7339(99)90093-7.

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HERMANNS, H., S. BRAUN, R. WERDEHAUSEN, A. WERNER, P. LIPFERT et M. STEVENS. « Skin Temperature After Interscalene Brachial Plexus Blockade ». Regional Anesthesia and Pain Medicine 32, n^o 6 (novembre 2007) : 481–87. http://dx.doi.org/10.1016/j.rapm.2007.06.392.

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Sarsu, Serkan, Ayse Mizrak et Gunhan Karakurum. « Tramadol Use for Axillary Brachial Plexus Blockade ». Journal of Surgical Research 165, n^o 1 (janvier 2011) : e23-e27. http://dx.doi.org/10.1016/j.jss.2010.09.032.

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MARTIN, R., L. BEAUREGARD et J. P. TÉTRAULT. « Brachial Plexus Blockade and Chronic Renal Failure ». Anesthesiology 69, n^o 3 (1 septembre 1988) : 405–6. http://dx.doi.org/10.1097/00000542-198809000-00020.

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Hermanns, Henning, Sebastian Braun, Robert Werdehausen, Andreas Werner, Peter Lipfert et Markus F. Stevens. « Skin Temperature After Interscalene Brachial Plexus Blockade ». Regional Anesthesia and Pain Medicine 32, n^o 6 (novembre 2007) : 481–87. http://dx.doi.org/10.1097/00115550-200711000-00005.

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Adam, H., et B. Hänsel. « Vertikale infraklavikuläre Technik zur Plexus-brachialis-Blockade ». AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie 39, n^o 12 (17 décembre 2004) : 728–34. http://dx.doi.org/10.1055/s-2004-826107.

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&NA;. « Pectorialis Major in Interscalene Brachial Plexus Blockade ». Regional Anesthesia and Pain Medicine 24, n^o 2 (mars 1999) : 190–91. http://dx.doi.org/10.1097/00115550-199924020-00026.

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Schaub, L., J. M. Badgwell et T. Mian. « Continuons brachial plexus blockade in a child ». Journal of Pain and Symptom Management 6, n^o 3 (avril 1991) : 164. http://dx.doi.org/10.1016/0885-3924(91)91037-a.

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Eifert, B., J. H�hnel et J. Kustermann. « Die axill�re Blockade des Plexus brachialis ». Der Anaesthesist 43, n^o 12 (1 décembre 1994) : 780–85. http://dx.doi.org/10.1007/s001010050123.

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Neuburger, M., H. Kaiser, B. �ss, C. Franke et H. Maurer. « Vertikale infraklavikul�re Plexus-brachialis-Blockade (VIP) ». Der Anaesthesist 52, n^o 7 (1 juillet 2003) : 619–24. http://dx.doi.org/10.1007/s00101-003-0526-7.

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Ali, Muhbat, Bashir Ahmed, Hamid Raza, Kamlaish Suchdev et Saqib Khan. « BRACHIAL PLEXUS BLOCK ». Professional Medical Journal 23, n^o 08 (10 août 2016) : 980–84. http://dx.doi.org/10.29309/tpmj/2016.23.08.1673.

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Objectives: The aim of our study is to find out the efficacy of dexamethasone(8mg) on prolonging the duration of motor and sensory blockade as used in brachial plexusblock required for forearm and hand surgeries. Study Design: Prospective randomized doubleblind trial. Period: April 2013 to May 2014, for a period of 14 months. Setting: Tertiary carehospital in Karachi Pakistan. Method: The study population consisted of 42 patients belongingto ASA classification, grades I and II, who underwent elective surgical procedures involving theforearm and hand. The patients were divided in to three groups, group A consisted of patientswho were given 2% of prilocaine at 5mg per kg of body weight, group B consisted of patientswho were given 2% of prilocaine with dexamethasone (8mg as 2ml) at group C consisted ofpatients who were given 0.5% of levobupivacaine at 1.5mg per kg of body weight. The timeduration and onset of sensory and motor blockade was duly noted for all the three groups.Data was analyzed using SPSS version 20. Results: The time of onset of motor and sensoryblock in group A and B, were very similar, there was a difference of longer duration was dulynoted in group C, which was statistically significant (p<0.001). In terms of the duration of block,a statistically significant difference was found when compared in the three groups (p<0.001).The duration of sensory and motor blockade was longer in Group C when compared to theother two groups, and they were found to be longer in group B when compared with group A(p<0.001). Side effects were not found in the study population due to small number of patientsevaluated. Conclusion: According to our study the addition of dexamethasone to the prilocaineused in hand and forearm surgeries resulted in increased duration of the sensory and motorblockade achieved. While levobupivacaine was found to be a very potent anesthetic when usedlocally for post op analgesia requirements and during long procedures.

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Stogicza, A., A. M. Trescot, E. Racz, L. Lollo, L. Magyar et E. Keller. « Inferior Hypogastric Plexus Block Affects Sacral Nerves and the Superior Hypogastric Plexus ». ISRN Anesthesiology 2012 (29 septembre 2012) : 1–5. http://dx.doi.org/10.5402/2012/686082.

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Background. The inferior hypogastric plexus mediates pain sensation through the sympathetic chain for the lower abdominal and pelvic viscera and is thought to be a major structure involved in numerous pelvic and perineal pain syndromes and conditions. Objectives. The objective of this study was to demonstrate the structures affected by an inferior hypogastric plexus blockade utilizing the transsacral approach. Study Design. This is an observational study of fresh cadaver subjects. Setting. The cadaver injections and dissections were performed at the Department of Forensic Sciences and Insurance Medicine, Semmelweis University, Budapest, Hungary after obtaining institutional review board approval. Methods. 5 fresh cadavers underwent inferior hypogastric plexus blockade with radiographic contrast and methylene blue dye injection by the transsacral fluoroscopic technique described by Schultz followed by dissection of the pelvic and perineal structures to localize distribution of the indicator dye. Radiographs demonstrating correct needle localization by contrast spread in the specific tissue plane and photographs of the dye distribution after cadaver dissection were recorded for each subject. Results. In all cadavers the dye spread to the posterior surface of the rectum and the superior hypogastric plexus. The dye also demonstrated distribution to the anterior sacral nerve roots of S1, 2, and 3 with bilateral spread in 3 cadavers and ipsilateral spread in 2 of them. Limitations. The small number of cadaver specimens in this study limits the results and generalization of their clinical significance. Conclusions. Inferior hypogastric plexus blockade by a transsacral approach results in distribution of dye to the anterior sacral nerve roots and superior hypogastric plexus as demonstrated by dye spread in freshly dissected cadavers and not by local anesthetic spread to other pelvic and perineal viscera.

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Singam, Amol, et Punith M. Sirige. « A Comparative Study of Bupivacaine 0.5 % and Ropivacaine 0.75 % for Supra-Clavicular Brachial Plexus Block Using Nerve Locator for Elective Upper Limb Orthopaedic Surgeries ». Journal of Evolution of Medical and Dental Sciences 10, n^o 24 (14 juin 2021) : 1825–29. http://dx.doi.org/10.14260/jemds/2021/377.

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BACKGROUND Regional anaesthesia has multiple advantages as compared to general anaesthesia for upper limb surgeries. Here in this study, we wanted to compare bupivacaine 0.5 %, commonly used anaesthetic with ropivacaine 0.75 % which has fewer side effects like cardiotoxicity for supraclavicular brachial plexus block. METHODS A study was performed on 60 ASA I & II patients aged between 18 and 75 years, undergoing upper limb elective surgeries under brachial plexus block using nerve locator. Beginning of sensory and motor block, general nature of block, and terms of sensory and motor blocks were assessed in the C5 to T1 dermatomes. RESULTS There was no statistically significant difference in the onset of sensory and motor blockade between ropivacaine 0.75 % and bupivacaine 0.5 %. Ropivacaine 0.75 % produced similar quality of motor and sensory blockade compared to 0.5 % bupivacaine. The time taken for maximum motor blockade with ropivacaine was comparable with that of bupivacaine 0.5 %. There was no statistically significant difference regarding the duration of analgesia with ropivacaine 0.75 % compared to bupivacaine 0.5 %. Duration of motor blockade with 0.75 % ropivacaine was comparable to that of 0.5 % bupivacaine. CONCLUSIONS Ropivacaine 0.75 % 0.4 ml / kg or 0.5 % bupivacaine 0.4 ml / kg for supraclavicular brachial plexus block produces satisfactory and comparable sensory and motor blockade. It is suggested that lower cardiovascular toxicity of ropivacaine with equal efficacy as bupivacaine in such circumstances may help in reducing the risks to the patient. KEY WORDS Bupivacaine 0.5 %, Ropivacaine 0.75 %, Brachial Plexus Block, Upper Limb Orthopaedic Surgeries

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Gungor, Irfan, Murat Zinnuroglu, Ayca Tas, Tolga Tezer et Mehmet Beyazova. « Femoral Nerve Injury Following a Lumbar Plexus Blockade ». Balkan Medical Journal 31, n^o 2 (10 juin 2014) : 184–86. http://dx.doi.org/10.5152/balkanmedj.2014.13179.

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Yadeau, Jacques T., Tiffany Tedore, Enrique A. Goytizolo, David H. Kim, Douglas S. T. Green, Anna Westrick, Randall Fan et al. « Lumbar Plexus Blockade Reduces Pain After Hip Arthroscopy ». Survey of Anesthesiology 57, n^o 4 (août 2013) : 200–201. http://dx.doi.org/10.1097/01.sa.0000431232.54157.0a.

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Kavakli, Ali Sait, Raif Umut Ayoglu, Nilgun Kavrut Ozturk, Kadir Sagdıc, Muzaffer Yilmaz, Kerem İnanoglu et Mustafa Emmiler. « Simultaneous Bilateral Carotid Endarterectomy under Cervical Plexus Blockade ». Turkish Journal of Anesthesia and Reanimation 43, n^o 5 (1 octobre 2015) : 367–70. http://dx.doi.org/10.5152/tjar.2015.87369.

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Barthoiomée, S., F. J. Singelyn, S. Broka et J. H. Gouverneur. « CLONIDINE ADDED TO HEPIVACAINE FOR BRACHIAL PLEXUS BLOCKADE ». Anesthesiology 75, n^o 3 (1 septembre 1991) : A1084. http://dx.doi.org/10.1097/00000542-199109001-01083.

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YaDeau, Jacques T., Tiffany Tedore, Enrique A. Goytizolo, David H. Kim, Douglas S. T. Green, Anna Westrick, Randall Fan et al. « Lumbar Plexus Blockade Reduces Pain After Hip Arthroscopy ». Anesthesia & ; Analgesia 115, n^o 4 (octobre 2012) : 968–72. http://dx.doi.org/10.1213/ane.0b013e318265bacd.

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Pirotta, D., et J. Sprigge. « Convulsions following axillary brachial plexus blockade with levobupivacaine ». Anaesthesia 57, n^o 12 (18 novembre 2002) : 1187–89. http://dx.doi.org/10.1046/j.1365-2044.2002.02860.x.

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Tolksdorf, W., M. Schmitt, A. Wetzel et P. Singer. « Simulationsstudie zur Plexus-coeliacus-Blockade anhand computertomographischer Bilder ». AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie 20, n^o 04 (août 1985) : 193–99. http://dx.doi.org/10.1055/s-2007-1003110.

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Cardozo, Larissa B., Ricardo M. Almeida, Levi C. Fiúza et Paula D. Galera. « Brachial plexus blockade in chickens with 0.75% ropivacaine ». Veterinary Anaesthesia and Analgesia 36, n^o 4 (juillet 2009) : 396–400. http://dx.doi.org/10.1111/j.1467-2995.2009.00467.x.

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Dolan, J. « Ultrasonography or nerve stimulation for lumbar plexus blockade ». Anaesthesia 70, n^o 11 (8 octobre 2015) : 1329. http://dx.doi.org/10.1111/anae.13279.

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Lemke, Kip A., et Catherine M. Creighton. « Paravertebral Blockade of the Brachial Plexus in Dogs ». Veterinary Clinics of North America : Small Animal Practice 38, n^o 6 (novembre 2008) : 1231–41. http://dx.doi.org/10.1016/j.cvsm.2008.06.003.

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Gu, Weidong, Wei Jiang, Jingwei He, Songbin Liu et Zhaoxin Wang. « Blockade of the Brachial Plexus Abolishes Activation of Specific Brain Regions by Electroacupuncture at Li4 : A Functional Mri Study ». Acupuncture in Medicine 33, n^o 6 (décembre 2015) : 457–64. http://dx.doi.org/10.1136/acupmed-2015-010901.

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Objective Our aim was to test the hypothesis that electroacupuncture (EA) at acupuncture point LI4 activates specific brain regions by nerve stimulation that is mediatied through a pathway involving the brachial plexus. Methods Twelve acupuncture naive right-handed volunteers were allocated to receive three sessions of EA at LI4 in a random different order (crossover): (1) EA alone (EA); EA after injection of local anaesthetics into the deltoid muscle (EA+LA); and (3) EA after blockade of the brachial plexus (EA+NB). During each session, participants were imaged in a 3 T MRI scanner. Brain regions showing change in blood oxygen level-dependent (BOLD) signal (activation) were identified. Subjective acupuncture sensation was quantified after functional MRI scanning was completed. Results were compared between the three sessions for each individual, and averaged. Results Blockade of the brachial plexus inhibited acupuncture sensation during EA. EA and EA+LA activated the bilateral thalamus, basal ganglia, cerebellum and left putamen, whilst no significant activation was observed during EA+NB. The BOLD signal of the thalamus correlated significantly with acupuncture sensation score during EA. Conclusions Blockade of the brachial plexus completely abolishes patterns of brain activation induced by EA at LI4. The results suggest that EA activates specific brain regions through stimulation of the local nerves supplying the tissues at LI4, which transmit sensory information via the brachial plexus. Trial Registration Number ChiCTR-OO-13003389.

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Zhang, Yanzi, Bo Cui, Chunyu Gong, Yidan Tang, Jianxiong Zhou, Yi He, Jin Liu et Jing Yang. « A rat model of nerve stimulator-guided brachial plexus blockade ». Laboratory Animals 53, n^o 2 (26 juillet 2018) : 160–68. http://dx.doi.org/10.1177/0023677218779608.

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It is important to develop a feasible animal model of regional anesthesia other than sciatic nerve blockade for pharmacokinetic investigations of new local anesthetics or analgesia in upper extremity surgery. Herein, we explored a nerve stimulator (NS)-guided brachial plexus block (BPB) in a rat model. The anatomy of the brachial plexus in rats was delineated in cadavers, and various BPBs were examined. The puncture point was located 0.5–1.0 cm below the lateral one-third of the clavicle. The efficacy and safety of the NS-guided BPB were evaluated using an injection of 2% lidocaine or 0.5% bupivacaine in 16 live animals; saline injection was used as a control. Both sides of the brachial plexus were located successfully using the NS-guided technique. Sensory blockade (nociception assessment) and motor blockade (grasping and straightening tests) appeared after application of the two classical local anesthetics, but not normal saline. The motor and sensory blockade induced by bupivacaine exhibited a longer duration than that induced by lidocaine ( p < 0.05). All rats recovered uneventfully from general anesthesia and BPB. No abnormal results were found in pathological studies or behavioral observations. Thus, a rat model of NS-guided BPB was established, and BPB induced an overall reversible sensory and motor blockade in the thoracic limbs. Evaluation of the efficacy and safety demonstrated that this rat BPB model was feasible, reproducible, and safe.

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Orebaugh, Steven L., et Brian A. Williams. « Brachial Plexus Anatomy : Normal and Variant ». Scientific World JOURNAL 9 (2009) : 300–312. http://dx.doi.org/10.1100/tsw.2009.39.

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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.

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Gadsden, Jeff C., Danielle M. Lindenmuth, Admir Hadzic, Daquan Xu, Lakshmanasamy Somasundarum et Kamil A. Flisinski. « Lumbar Plexus Block Using High-pressure Injection Leads to Contralateral and Epidural Spread ». Anesthesiology 109, n^o 4 (1 octobre 2008) : 683–88. http://dx.doi.org/10.1097/aln.0b013e31818631a7.

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Background The main advantage of lumbar plexus block over neuraxial anesthesia is unilateral blockade; however, the relatively common occurrence of bilateral spread (up to 27%) makes this advantage unpredictable. The authors hypothesized that high injection pressures during lumbar plexus block carry a higher risk of bilateral or neuraxial anesthesia. Methods Eighty patients undergoing knee arthroscopy (age 18-65 yr; American Society of Anesthesiologists physical status I or II) during a standard, nerve stimulator-guided lumbar plexus block using 35 ml mepivacaine, 1.5%, were scheduled to be studied. Patients were randomly assigned to receive either a low-pressure (< 15 psi) or a high-pressure (> 20 psi) injection, as assessed by an inline injection pressure monitor (BSmart; Concert Medical LLC, Norwell, MA). The block success rate and the presence of bilateral sensory and/or motor blockade were assessed. Results An interim analysis was performed at n = 20 after an unexpectedly high number of patients had neuraxial spread, necessitating early termination of the study. Five of 10 patients (50%) in the high-pressure group had a neuraxial block with a dermatomal sensory level T10 or higher. In contrast, no patient in the low-pressure group (n = 10) had evidence of neuraxial spread. Moreover, 6 patients (60%) in the high-pressure group demonstrated bilateral sensory blockade in the femoral distribution, whereas no patient in the low-pressure group had evidence of a bilateral femoral block. Conclusions Injection of local anesthetic with high injection pressure (> 20 psi) during lumbar plexus block commonly results in unwanted bilateral blockade and is associated with high risk of neuraxial blockade.

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Broderick, Alan J., et Stephen Mannion. « Brachial Plexus Blockade as a Result of Aberrant Anatomy After Superficial Cervical Plexus Block ». Regional Anesthesia and Pain Medicine 35, n^o 5 (septembre 2010) : 476–77. http://dx.doi.org/10.1097/aap.0b013e3181ef4b90.

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Tokat, O., YG Türker, N. Uckunkaya et A. Yilmazlar. « A Clinical Comparison of Psoas Compartment and Inguinal Paravascular Blocks Combined with Sciatic Nerve Block ». Journal of International Medical Research 30, n^o 2 (avril 2002) : 161–67. http://dx.doi.org/10.1177/147323000203000208.

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The extent of inguinal paravascular blockade and psoas compartment blockade with sciatic nerve block was evaluated in 60 patients. Volumes of 30 ml and 20 ml 0.35% bupivacaine with 1/200 000 epinephrine were injected for lumbar plexus and sciatic nerve block, respectively. Complete lumbar plexus blockade was achieved in 73% of the group who were treated with the psoas compartment technique and 43% of the group who were treated with the inguinal paravascular technique. Sensory blockade of the femoral, lateral femoral cutaneous and obturator nerves was obtained in 100%, 97% and 77% of the patients in the psoas compartment group, and 93%, 63% and 47% of the patients in the inguinal paravascular group, respectively. Sensory blockade of the lateral femoral cutaneous and obturator nerves was more rapid with psoas compartment block. The study suggests that the psoas compartment block is effective in blocking the femoral, lateral femoral cutaneous and obturator nerves, but the inguinal paravascular block is only effective in blocking the femoral nerve.

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