Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2
Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2
Chapter 13Upper extremity blocks13 1 General anatomical considerationsThe brachial plexus is formed by the ventral rami of the spinal nerves (5-11. In Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2n general, supraclavicular and infraclavicular parts are described. The ventral rami leave (he intervertebral foramina posterior to the vertebral artery and after a short distance in the scale novertebral triangle (bordered by the longus colli muscle medially, the anterior scalenus muscle laterally, Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2 and the dome of (he pleura inferiorly), they arc situated between the anterior and middle scalene muscles (the inlerscalene space). The first blancheEbook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2
s are the dorsal scapular and thoracic longus nerves, both of which pierce the middle scalenus muscle to take a dorsolateral course. Subsequently, theChapter 13Upper extremity blocks13 1 General anatomical considerationsThe brachial plexus is formed by the ventral rami of the spinal nerves (5-11. In Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2erve which shows a variable level of origin out of the superior trunk. Between the level of the first rib and the clavicle, each trunk bifurcates into an anterior and posterior portion to be rearranged and form the three cords of the brachial plexus. A lateral cord is formed by (he anterior portion Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2of the superior and middle trunks, a medial cord by the anterior portion of the inferior trunk, and a posterior cord by the posterior portions of allEbook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2
three trunks, rhe nomenclature of the three cords (lateral, medial, and posterior) refers to their position around the axillary artery. Note that theiChapter 13Upper extremity blocks13 1 General anatomical considerationsThe brachial plexus is formed by the ventral rami of the spinal nerves (5-11. In Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2superficial one is the lateral cord, followed by the posterior and medial cord as the deepest.The brachial plexus is covered by connective tissue from its origin down to the axillary level. Various septae between the cords and nerves of the plexus appear to be responsible for incomplete nerve blocka Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2de, particularly at the axillary level when single-injection techniques arc used.102 UPPER EXTREMITY BLOCKS13.2Interscalene brachial plexus approach13Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2
.2.1 AnatomyThe interscalene groove is bordered by the anterior scalenus muscle medially, the middle scalenus muscle laterally, and the first rib infeChapter 13Upper extremity blocks13 1 General anatomical considerationsThe brachial plexus is formed by the ventral rami of the spinal nerves (5-11. In Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2ite side. Of note, the interscalene groove is covered more or less by the sternocleidomastoid muscle in the case of a neutral head position. The scalene muscles and the brachial plexus are covered by the preverlebral layer of the cervical fascia. Figure 13.2 illustrates the ultrasound anatomy of the Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2 brachial plexus at the level of the interscalene groove.Pin 13 1 únatnmiralimann nf thn nnn/í' rnritc rrf thn hrarhial nlỡYiicINTERSCALENE BRACHIAL PEbook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2
LEXUS APPROACH ị 103Fig. 13.2 Ultrasound image of the posterior interscalene groove.The C5 8 nerve roots are located lateral to the sternocleidomastoiChapter 13Upper extremity blocks13 1 General anatomical considerationsThe brachial plexus is formed by the ventral rami of the spinal nerves (5-11. In Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2n receives a communication from the ventral ramus C4. In this case, the plexus is situated more cephalic in relation to the cervical spine and designated as high or prefixed. In prefixed plexuses, C4 provides a large branch and the ventral ramus T1 appears small. When receiving the majority of commu Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2nications from the ventral ramus (3, the brachial plexus is located more caudally and considered to be low or poslfixed. In postfixed plexuses, the veEbook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2
ntral ramus ol'Tl is large with an additional branch to the plexus provided by T2.Variants of the course of the brachial plexus and its components havChapter 13Upper extremity blocks13 1 General anatomical considerationsThe brachial plexus is formed by the ventral rami of the spinal nerves (5-11. In Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2he lateral border of the sternocleidomastoid muscle, rhe C5-C7 roots may pierce the anterior scalenus muscle either together or separately (Figure 13.3). In some cases, only C5 pierces the anterior scalenus. These situations were found to occur unilaterally or bilaterally to the same extent. In a sm Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2aller number of cases, the C5 root may be found completely anterior to the anterior scalenus muscle (Figure 13.4). A scalenus minimus muscle maybe preEbook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2
sent which is visualized as a small muscle slip running anterior to one or two of the roots. In a significant number of cases, a muscle bridge is locaChapter 13Upper extremity blocks13 1 General anatomical considerationsThe brachial plexus is formed by the ventral rami of the spinal nerves (5-11. In Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2Ultrasound image of the C5 root piercing the anterior scalene muscle (ASM).The C6 and 7 roots are located between the ASM and the median scalene muscles (MSM). SCM: sternocleidomastoid muscle; left side-lateral.Fig. 13.4 Ultrasound image of the C5 root anterior to the anterior scalene muscle (ASM) a Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2nd completely outside the posterior interscalenc groove (white arrows). SCM: sternocleidomastoid muscle; MSM: middle scalene muscle; left side-lateralEbook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2
.INTERSCALENE BRACHIAL PLEXUS APPROACH ị 105Fig. 13.6 Ultrasound image of the bifurcations of the nerve roots inside the posterior interscalene grooveChapter 13Upper extremity blocks13 1 General anatomical considerationsThe brachial plexus is formed by the ventral rami of the spinal nerves (5-11. In Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2rnocleidomastoid muscle; ASM: anterior scalene muscle; MSM: middle scalene muscle; left side-medial.13.2.3Ultrasound guidance techniqueUltrasound investigation starts at the middle of the neck, at the level where the larynx is most prominent and the greater vessels of the neck are easy visible. Ther Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2eafter, the probe is moved slowly in a lateral direction up to the lateral border of the sternocleidomastoid muscle. Once the lateral border of the stEbook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2
ernocleidomastoid muscle and the anterior and middle scalene muscles are visible, the position of the probe relative to the skin should be slightly moChapter 13Upper extremity blocks13 1 General anatomical considerationsThe brachial plexus is formed by the ventral rami of the spinal nerves (5-11. In Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2intcrsca-lene groove as round or oval hypoechoic structures (Figure 13.2). When scanned more distally, the bifurcations may be visualized (Figure 13.6).13 2 4 Practical block techniqueIt should be taken into consideration that the external jugular vein is usually visible in the final probe position. Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2 The puncture site should therefore be chosen medial or lateral to the external jugular vein.The needle direction relative to the position of the probEbook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2
e should be OOP from cranial (Figure 13.7). Taking a posterior approach using the IP technique can lead to the potential disadvantage of the needle moChapter 13Upper extremity blocks13 1 General anatomical considerationsThe brachial plexus is formed by the ventral rami of the spinal nerves (5-11. In Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2f the needle relative to the ultrasound probe for the interscalene block technique.Fig. 13.8 Ultrasound image of a nerve structure (yellow arrow) inside the middle scalene muscle.The white arrow indicates the nerve roots inside the posterior intersca-lene groove. SCM: sternocleidomastoid muscle; MSM Ebook Ultrasound guidance in regional anaesthesia -Principles and practical implementation (2nd edition): Part 2: middle scalene muscle; ASM: anterior scalene muscle; left side-lateral.Chapter 13Upper extremity blocks13 1 General anatomical considerationsThe brachial plexus is formed by the ventral rami of the spinal nerves (5-11. InChapter 13Upper extremity blocks13 1 General anatomical considerationsThe brachial plexus is formed by the ventral rami of the spinal nerves (5-11. InGọi ngay
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