Optimization of ultrasound navigation techniques for brachial plexus block using proximal subclavian access

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Abstract

BACKGROUND: When performing a brachial plexus block in the proximal subclavian region, the scanning plane is located deeper and posterior to the clavicle midpoint. Data on the angle of the ultrasound probe and visualization of the brachial plexus bundles are limited.

AIM: Our aim was to evaluate visualization and positioning of the neurovascular bundle in the infraclavicular region for proximal brachial plexus block..

MATERIALS AND METHODS: Volunteer patients (добровольцах (n=28, median — 43 years)) at the Military Traumatology and Orthopedics Clinic of the Military Medical Academy, named after S.M. Kirov, were studied. Ultrasound navigation was used to evaluate the neurovascular bundle followed by brachial plexus block.

RESULTS: The study showed that the brachial plexus bundle is best visualized at an average sensor angle of between 90° and the maximum that allows visualization of at least one of the elements of the brachial plexus 64.4° (65.7°, 63°) and amounted to 77.5° (77.9°, 76.5°).

CONCLUSION: The optimal angle for performing a brachial plexus block using the proximal subclavian approach is 77.5°. Optimal visualization of the brachial plexus is possible in the angle range from 64.4° to 90°, which enables selecting the safest trajectory of the needle when performing a blockade in this area, considering the anatomical characteristics of the patient. Further studies are required to compare the sensor angles used in actual clinical practice to the angles obtained in this study.

About the authors

Vasily G. Tsvetkov

Kirov Military Medical Academy

Author for correspondence.
Email: vasilii_cvetkov@mail.ru
ORCID iD: 0000-0003-4980-597X
SPIN-code: 5316-4617
Russian Federation, St. Petersburg

Roman E. Lakhin

Kirov Military Medical Academy

Email: doctor-lahin@yandex.ru
ORCID iD: 0000-0001-6819-9691
SPIN-code: 7261-9985

MD, Dr. Sci. (Med.), Associate Professor

Russian Federation, St. Petersburg

Evgeniy V. Polezhankin

Kirov Military Medical Academy

Email: vasilii_cvetkov@mail.ru
ORCID iD: 0009-0007-6311-1698
Russian Federation, St. Petersburg

Evgeniy V. Chartorizhsky

Kirov Military Medical Academy

Email: chev89@mail.ru
ORCID iD: 0000-0002-9684-9783
SPIN-code: 8909-1230
Russian Federation, St. Petersburg

Kirill A. Tsygankov

Kirov Military Medical Academy

Email: doctorcygankov@mail.ru
ORCID iD: 0000-0002-2357-0685
SPIN-code: 7133-0503

MD, Cand. Sci. (Med.)

Russian Federation, St. Petersburg

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Supplementary files

Supplementary Files
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2. Fig. 1. Study design.

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3. Fig. 2. First stage: а — marking, b — visualization of the exit site of the subclavian artery from under the clavicle, c, d — taking measurements.

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4. Fig. 3. Second phase — an ultrasound image obtained when the sensor is installed perpendicular to the surface of the skin: v.a. — axillary vein, a.a. — axillary artery, p.br. — brachial plexus.

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5. Fig. 4. Third stage: а, b — sensor location perpendicular to the skin surface, c, d — inclined location of the sensor, p.br. — brachial plexus.

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