Fascial planes for regional anaesthesia of the upper limb
Authors:
D. Nalos
Authors‘ workplace:
Klinika anesteziologie, perioperační a intenzivní medicíny Univerzita J. E. Purkyně v Ústí nad Labem, Masarykova nemocnice v Ústí nad Labem
Published in:
Anest. intenziv. Med., 30, 2019, č. 5, s. 225-234
Category:
Overview
The article is another chapter in the series describing the importance of the fascias for regional anaesthesia. This chapter deals with the fascial planes of the nerves supplying the upper limb. The main vascular and nerve bundles for the cervical region run on the neck between deep and superficial fascias. There are several separate fascial planes under the deep cervical fascia, in which the individual nerves and the brachial plexus take place. The unique fascial function of the omohyoid muscle is newly described as a link between the deep and superficial fascial structures and the path for the suprascapular and infraclavicular nerves. The transition point between the fascias of the neck and upper limb is in the area of the first rib. This area is also important for the arrangement of the fascias and structures of the neural plexuses. The main peripheral nerves of the hand are formed here and the arrangement of innervation changes. The next part is devoted to the description of the axillary area, its shape, fascias and properties of the brachial plexus in the axilla. The last part is devoted to the peripheral nerves and their fascial planes on the upper limb which are suitable for ultrasonically assisted blockade.
Keywords:
regional anaesthesia – ultrasound – fascia – upper limb
Sources
1. Nalos D, Doležal D, Mach D. Nové horizonty v regionální anestezii – fascie a ultrazvuk. Anest intenziv Med. 2019;30:80–85.
2. Nalos D. Fasciální prostory na krku pro regionální anestezii. Anest intezi Med. (v tisku)
3. Nalos D, Mach D. Periferní nervové blokády. 1. vyd. Praha: Grada, 2010: 100.
4. Andreae MH, Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis. J Anaesth. 2013;111:711–720.
5. Stecco C. Functional atlas of the human fascial system. Edinburgh, UK: Churchilll Livingstone Elsevier, 2015:59.
6. Lesondak D. Fascia. Handspring Publishing, 2017.
7. Adstrum S, Hedley G, Schleip R, et al. Defining the fascial system. J Bodyw Mov Ther. 2017;21:173–177.
8. Guidera AK, Dawes PJ, Fong A, Stringer MD. Head and neck fascia and compartments: no space for spaces. Head Neck. 2014;36:1058–1068.
9. Čihák R. natomie 1. 2. vyd. Praha: Grada, 2001:497.
10. Urmey WF, Mc Donald. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anest Analg. 1991;72:498–503.
11. Riazy S, et al. Effect of local anesthetic volume (20 vs 5 ml) on efficacy and respirátory consequences of ultrasound guided interscalene brachial plexus block. Br J Anaesth. 2008;101.
12. Aliste J, Bravo D, Fernández D, et al. A Randomized comparison between interscalene and small-volume suprasclavicular blocks for artroscopic shoulder surgery. Reg Anesth Pain Med. 2018;43:712–719.
13. Tran DQH, Elgueta MF, Aliste J, Finlayson RJ. Diaphragm-sparing nerve blocks for shoulder surgery. Reg Anesth Pain Med. 2017;42:32–38.
14. Kang RA, Chung YH, Sangwook J, et al. Reduced hemidiapfragmatic paresis with a „corner pocket“ technique for supraclavicular brachial plexus block: single-center, obsever-blinded, randomized controlled trial. Reg Anesth Pain Med. 2016;43:195–204.
15. Auyong DB, et al. Comparison of anterior suprascapular, supraclavicular, and interscalene block approaches for major outpatient artroscopic shoulder surgery. Anesthesiology. 2018;129:47.
16. Winnie AP, Ramamurthy S, Durrani Z, Radonjic R. Interscalene cervical plexus block: a single-injection technic. Anesth Analg. 1975;54:370–375.
17. Nalos D. Infraklavikulární blokáda brachiálního plexu. Anest neodklad Péče. 1993;4:98–99.
18. Choi S, McCartney CJL. Evidence base for the use of ultrasound for upper extremity blocks: 2014 Update. Reg Anesth Pain Med. 2016;41:242–251.
19. Vandepitte K, Lopez AM, Jalil H. In: Hadzi´s Textbook of Regional Anesthesia. 2nd ed. Mc Graw-Hill edition, 580–585.
Labels
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2019 Issue 5
Most read in this issue
- Negative pressure pulmonary edema
- Fascial planes for regional anaesthesia of the upper limb
- Abstrakty XXVI. kongresu ČSARIM Brno 2019
- How did we learn to „control“ the heart...