Method of brachial plexus block in upper extremity surgeries

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anesthesiology, and can be used where block brachial plexure anaesthesia required in upper extremity surgeries. For this purpose, a first needle stick point is arranged on a periphery edge of a subclavian artery 1 cm above a posteromedial edge of a clavicle. A second needle stick point is located in an axillary cavity below an axillary pulsation over a head of humerus.

EFFECT: method enables safe adequate block anaesthesia in appropriate surgeries due to additional ulnar nerve block.

2 ex

 

The present invention relates to medicine, in particular to anesthesiology, and can be used for regional anesthesia of the brachial plexus surgeries of the upper limb.

There are various ways to blockade of the brachial plexus, for example majesticly (see Winnie A.P. Interscalene brachial plexus block. Anest. Play mode display. 1970, - v.49, p.455-466), axillary (see Hershel, Manual of local anesthesia. - L.: Practical medicine, 1929. - S-155) accesses, the choice of which is determined by the localization of surgical intervention.

However majesticly access is used only for operations in the area of the upper arm and underarm access is used when surgery of the forearm and hand.

As a prototype of the selected method blockade of the brachial plexus, which consists in determining the distance of the point vcol needle relative to the subclavian artery and jugular-acromiale distance and subsequent injection of local anesthetic (Hirsel, Manual of local anesthesia. - Leningrad: Izd-vo "Practical medicine", 1929. - s-158).

However, this method does not provide adequate anesthesia for operations on the upper limb due to insufficient blockade of the ulnar nerve (30%), extending from the lower trunk of the brachial plexus, requires deep sedation and increasing the risk of anesthesia.

The task before aguinaga the invention, reduction of complications, ensuring safe and effective anesthesia.

The problem is solved by a method that includes determining the location of the point vcol needle relative to the subclavian artery and jugular-acromiale distance and the injection of local anesthetic, an additional point vcol have lower pulsation of the axillary artery at the level of the humeral head.

The way the blockade of the brachial plexus surgeries of the upper limb is as follows: position the patient on his back, head turned in the opposite direction from the site of blockage. Under the head put a thin pillow to relax the neck muscles and facilitate palpation of the subclavian artery. Then mark the middle of the clavicle and 1 cm above are approximate point vcol. After that, the target point to determine the pulsation of the subclavian artery, celebrated its outer edge, and if possible alperujo trunks of the brachial plexus. Based on these topographic-anatomic construction choose a point vcol needle: the outer edge of the artery if it is palpable 1 cm above the posteromedial edge of the clavicle. The needle is injected at an angle of 60° to the frontal plane in the direction of the spinous process of the second or third thoracic vertebra. The depth of the needle is limited to arwym rib, which means that the entire thickness of the brachial plexus passed. Needle tighten on itself and repeat the search plexus. Upon reaching the first edge mark the depth of the needle, so that when further search plexus needle passed deeper ribs, as this may damage the tops of lung development hemo-pneumothorax. After verification of the position of the needle tip relative to the nerve trunks and positive Electrotest the entire volume of local anesthetic (30-40 ml of 1% lidocaine and 0.25% solution of marcaine) injected from one vcol without moving the needle.

Then, without waiting for the blockade of the brachial plexus, produce additional blockade of the ulnar nerve axillary access: the hand of the patient away at a right angle at the shoulder joint, in the armpit, above the head of the humerus alperujo axillary artery and mark the point vcol under the artery with the direction of the needle during puncture perpendicularly to the surface of the shoulder. After verification of the needle position relative to the nerve trunks of the point vcol injected 15-20 ml of local anesthetic solution.

Clinical examples:

Patient M, 53,,/b, No. 240746. Body weight 83 kg

Diagnosis: dead fracture of the right humerus in the bottom third with displacement of fragments. Operation: intramedullary osteosynthesis of humerus crucial is eat UTN with blocking under the control of the electro-optical Converter).

Anesthesia: blockade of the right brachial plexus. After sedation (Relanium (diazepam) 5 mg intravenously) made supraclavicular blockade of the brachial plexus. After verification of the position of the needle tip relative to its elements introduced 20 ml of 0.25% marcaine. Then run the blockade of the ulnar nerve axillary access below the axillary artery at the level of the humeral head with the introduction of 25 ml of 0.25% marcaine.

After development unit started operation. Intravenous sedation - Relanium - 10 mg, fentanyl - 100 µg fractionally. Blockade adequate. Sedation surface. Breathing self, 14-16 in minutes Hemodynamics stable, level Adsit. - 128-150 mm Hg, heart rate is 70-75 in minutes the Duration 70 min, for smooth operation, without features. There were no complications. The patient was transferred to the ward. The first injection of a narcotic analgesic is made through 5.5 hours after the operation.

Patient G., age 17, and a/b No. 200390. Weight 58 kg

Diagnosis: post-traumatic deforming arthrosis of the left elbow joint, chondromatous.

Activity: mobilization of the left elbow joint, remove chondromatosis phone

Anesthesia: blockade of the left brachial plexus. After sedation (Relanium (diazepam) 5 mg) made supraclavicular blockade of the brachial plexus by Kulenkampff introduced 20 ml of 0.25% marcaine, then run the blockade of the ulnar nerve axillary what access below the axillary artery at the level of the humeral head, put 20 ml of 0.25% marcaine. The block is full. Intraoperative sedation - 10 mg Relanium and 100 mcg of fentanyl intravenously. Surgery duration 75 minutes For anesthesia smooth, no complications. The spontaneous breathing 16-18 in minutes stable Hemodynamics, Adsit. - 110-130 mm Hg, HR - 62-88 in minutes After the operation the patient was transferred to the ward.

The proposed method is applied in 26 patients with fractures of the humerus in the middle and lower thirds. The method improves the efficiency and adequacy of regional anesthesia, broadens the scope of surgical interventions under this type of anesthesia, increases the safety of anesthesia. The method provides prolonged postoperative analgesia (5-9 h), which contributes to early activation of patients after surgery, reduces the use of narcotic analgesics and reduces the likelihood of adverse effects from their use (nausea, vomiting, respiratory depression, hypotension, and others).

Thus, the proposed method blockade of the brachial plexus surgeries of the upper limb provides adequate anesthesia for operations on the upper, middle and lower third of the shoulder.

The way the blockade of the brachial plexus during operations on the upper limb, consisting of the location of the point vcol needle on the outer edge of the subclavian artery 1 cm above the posteromedial edge of the clavicle is, characterized in that an additional point of vcol have in the armpit below the pulsation of the axillary artery above the humeral head.



 

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