Infraclavicular block in paediatric anaesthesia: Concordance between the modified Wilson approach and ultrasound in determining the ideal puncture site
Keywords:
Anesthesia, Conduction ultrasonography, Brachial plexus, Pediatrics, Nerve block
Abstract
Introduction: The modified Wilson infraclavicular approach (MWIA) was described in our institution for brachial plexus blocks in paediatric patients. However, concordance studies between this approach and ultrasound for the identification of ideal puncture site have no been reported.
Objective: To determine the concordance between MWIA and ultrasound for localization of the ideal puncture site.
Materials and methods: Descriptive observational study; we included 100 healthy patients between 1 and 16 years of age, with parental consent, over a 5-month period. Continuous variables were described and kappa statistics were used for concordance evaluation. We also conducted a multivariate analysis to confirm the relationship between the measured distances and weight and height.
Results: The distance fromthe skin to the brachial plexus, aswell as the distance between the coracoid process and the brachial plexus, and the distance from the coracoid process to the pleura were all smaller in abduction, with no statistically significant difference. Height and weight are independent factors that determine the distance between the coracoid process and the posterior cord, both in adduction and abduction. The concordance of MWIA vs. ultrasound for determining the ideal puncture site was 47% in both positions.
Conclusions: Concordance between MWIA and ultrasound for the determination of the ideal puncture site is low when it comes to anatomic localization; however, this technique must be evaluated in randomized clinical studies in order to determine its efficacy and usefulness. Height and weight are independent factors that determine the distance between the coracoid process and the posterior cord in adduction and abduction.
References
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20. Rodriguez J, Barcena M, Alvarez J. Restricted infraclavicular distribution of the local anesthetic solution after infraclavicular brachial plexus block. Reg Anesth Pain Med. 2003;28:33-6.
21. Whiffler K. Coracoid block - a safe and easy technique. Br J Anaesth. 1981;53:845-8.
22. Greher M, Retzl G, Niel P, Kamolz L, Marhofer P, Kapral S. Ultrasonographic assessment of topographic anatomy in volunteers suggests a modification of the infraclavicular vertical brachial plexus block. Br J Anaesth. 2002;88:632-6.
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24. Kapral S, Jandrasits O, Schabernig C, Likar R, Reddy B, Mayer N, et al. Lateral infraclavicular plexus block vs. axillary block for hand and forearm surgery. Acta Anaesthesiol Scand. 1999;43:1047-52.
25. Fleischmann E, Marhofer P, Greher M, Waltl B, Sitzwohl C, Kapral S. Brachial plexus anaesthesia in children: lateral infraclavicular vs axillary approach. Paediatr Anaesth. 2003;13:103-8.
26. Ponde V, Athani B, Thruppal S. Infraclavicular coracoid approach brachial plexus block for radial club hand repair. Paediatr Anaesth. 2007;17:863-6.
27. Klaastad O, Smith HJ, Smedby O, Winther-Larssen EH, Brodal P, Breivik H, et al. A novel infraclavicular brachial plexus block: the lateral and sagittal technique, developed by magnetic resonance imaging studies. Anesth Analg. 2004;98:252-6.
28. Sedeek KA, Goujard E. The lateral sagittal infraclavicular block in children. Anesth Analg. 2007;105:295-7.
29. Gurkan Y, Ozdamar D, Solak M, Toker K. Lateral sagittal infraclavicular block is a clinically effective block in children. Eur J Anaesth. 2008;25:949-51.
30. Marhofer P, Sitzwohl C, Greher M, Kapral S. Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children. Anaesthesia. 2004;59:642-6.
31. Dillane D, Tsui BC. Is there still a place for the use of nerve stimulation? Paediatr Anaesth. 2012;22:102-8.
32. Gadson J. Monitoring and documentation. In: Hadzic A, editor. Hadzic's peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia. New York: McGraw-Hill; 2012. p. 71-9.
33. Marhofer P. Ultrasound guidance for nerve blocks. Principles and practical implementation. 1st ed. New York: Oxford University Press; 2008.
34. Kuo YW, Lu IC, Yen MK, Soo LY, Lu DV, Chu KS. The feasibility of surface landmark for coracoid infraclavicular brachial plexus block by ultrasonographic assessment. Acta Anaesthesiol Taiwanica. 2007;45:27-32.
35. Sauter AR, Smith HJ, Stubhaug A, Dodgson MS, Klaastad O. Use of magnetic resonance imaging to define the anatomical location closest to all three cords of the infraclavicular brachial plexus. Anesth Analg. 2006;103:1574-6.
36. Cornish PB, Nowitz M. A magnetic resonance imaging analysis of the infraclavicular region: can brachial plexus depth be estimated before needle insertion? Anesth Analg. 2005;100:1184-8.
37. Sinner B, Becke K, Engelhard K. Neurotoxicity of general anesthetics in childhood: does anesthesia leave its mark on premature babies, newborns and infants? Der Anaesth. 2013;62:91-100.
38. Olsen EA, Brambrink AM. Anesthetic neurotoxicity in the newborn and infant. Curr Opin Anaesthesiol. 2013;26:535-42.
39. Davidson AJ. Anesthesia and neurotoxicity to the developing brain: the clinical relevance. Paediatr Anaesth. 2011;21:716-21.
40. Leiner T, de Jong PA, Nievelstein RA. CT scans in children and adolescents: only when appropriate and when optimized. Ned Tijdschr Geneeskd. 2013;157:A6711.
41. Ruiz A, Sala X, Bargallo X, Hurtado P, Arguis MJ, Carrera A. The influence of arm abduction on the anatomic relations of infraclavicular brachial plexus: an ultrasound study. Anesth Analg. 2009;108:364-6.
42. Ecoffey C, Lacroix F, Giaufre E, Orliaguet G, Courreges P, Association des Anesthesistes Reanimateurs Pediatriques d'Expression F. Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Paediatr Anaesth. 2010;20:1061-9.
2. Shah SS, Rochette LM, Smith GA. Epidemiology of pediatric hand injuries presenting to United States emergency departments, 1990 to 2009. J Trauma Acute Care Surg. 2012;72:1688-94.
3. Bates SJ, Hansen SL, Jones NF. Reconstruction of congenital differences of the hand. Plast Reconstr Surg. 2009;124:128e-43e.
4. Polaner DM, Taenzer AH, Walker BJ, Bosenberg A, Krane EJ, Suresh S, et al. Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesth Analg. 2012;115:1353-64.
5. Bosenberg A. Neuraxial blockade and cardiac surgery in children. Paediatr Anaesth. 2003;13:559-60.
6. Bosenberg A. Pediatric regional anesthesia update. Paediatr Anaesth. 2004;14:398-402.
7. Bosenberg AT. Epidural analgesia for major neonatal surgery. Paediatr Anaesth. 1998;8:479-83.
8. Kehlet H. Epidural analgesia and postoperative outcome. Lancet. 2008;372:2109.
9. Kehlet H. Fast-track colorectal surgery. Lancet. 2008;371:791-3.
10. Tsui B, Suresh S. Ultrasound imaging for regional anesthesia in infants, children, and adolescents: a review of current literature and its application in the practice of extremity and trunk blocks. Anesthesiology. 2010;112:473-92.
11. Willschke H, Marhofer P, Machata AM, Lonnqvist PA. Current trends in paediatric regional anaesthesia. Anaesthesia. 2010;65 Suppl. 1:97-104.
12. Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney JL, Franco CD, et al. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med. 2009;34:134-70.
13. Hadzic A. Textbook of regional anesthesia and acute pain management. McGraw Hill; 2010.
14. Salazar CH, Espinosa W. Infraclavicular brachial plexus block: variation in approach and results in 360 cases. Reg Anesth Pain Med. 1999;24:411-6. 15. Wilson JL, Brown DL, Wong GY, Ehman RL, Cahill DR.
15. Infraclavicular brachial plexus block: parasagittal anatomy important to the coracoid technique. Anesth Analg. 1998;87:870-3.
16. Koscielniak-Nielsen ZJ, Rasmussen H, Hesselbjerg L, Gurkan Y, Belhage B. Clinical evaluation of the lateral sagittal infraclavicular block developed by MRI studies. Reg Anesth Pain Med. 2005;30:329-34.
17. Rettig HC, Gielen MJ, Boersma E, Klein J, Groen GJ. Vertical infraclavicular block of the brachial plexus: effects on hemidiaphragmatic movement and ventilatory function. Reg Anesth Pain Med. 2005;30:529-35.
18. Raj PP, Montgomery SJ, Nettles D, Jenkins MT. Infraclavicular brachial plexus block - a new approach. Anesth Analg. 1973;52:897-904.
19. Sims JK. A modification of landmarks for infraclavicular approach to brachial plexus block. Anesth Analg. 1977;56:554-5.
20. Rodriguez J, Barcena M, Alvarez J. Restricted infraclavicular distribution of the local anesthetic solution after infraclavicular brachial plexus block. Reg Anesth Pain Med. 2003;28:33-6.
21. Whiffler K. Coracoid block - a safe and easy technique. Br J Anaesth. 1981;53:845-8.
22. Greher M, Retzl G, Niel P, Kamolz L, Marhofer P, Kapral S. Ultrasonographic assessment of topographic anatomy in volunteers suggests a modification of the infraclavicular vertical brachial plexus block. Br J Anaesth. 2002;88:632-6.
23. Marhofer P. Vertical infraclavicular brachial plexus block in children: a preliminary study. Paediatr Anaesth. 2005;15:530-1.
24. Kapral S, Jandrasits O, Schabernig C, Likar R, Reddy B, Mayer N, et al. Lateral infraclavicular plexus block vs. axillary block for hand and forearm surgery. Acta Anaesthesiol Scand. 1999;43:1047-52.
25. Fleischmann E, Marhofer P, Greher M, Waltl B, Sitzwohl C, Kapral S. Brachial plexus anaesthesia in children: lateral infraclavicular vs axillary approach. Paediatr Anaesth. 2003;13:103-8.
26. Ponde V, Athani B, Thruppal S. Infraclavicular coracoid approach brachial plexus block for radial club hand repair. Paediatr Anaesth. 2007;17:863-6.
27. Klaastad O, Smith HJ, Smedby O, Winther-Larssen EH, Brodal P, Breivik H, et al. A novel infraclavicular brachial plexus block: the lateral and sagittal technique, developed by magnetic resonance imaging studies. Anesth Analg. 2004;98:252-6.
28. Sedeek KA, Goujard E. The lateral sagittal infraclavicular block in children. Anesth Analg. 2007;105:295-7.
29. Gurkan Y, Ozdamar D, Solak M, Toker K. Lateral sagittal infraclavicular block is a clinically effective block in children. Eur J Anaesth. 2008;25:949-51.
30. Marhofer P, Sitzwohl C, Greher M, Kapral S. Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children. Anaesthesia. 2004;59:642-6.
31. Dillane D, Tsui BC. Is there still a place for the use of nerve stimulation? Paediatr Anaesth. 2012;22:102-8.
32. Gadson J. Monitoring and documentation. In: Hadzic A, editor. Hadzic's peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia. New York: McGraw-Hill; 2012. p. 71-9.
33. Marhofer P. Ultrasound guidance for nerve blocks. Principles and practical implementation. 1st ed. New York: Oxford University Press; 2008.
34. Kuo YW, Lu IC, Yen MK, Soo LY, Lu DV, Chu KS. The feasibility of surface landmark for coracoid infraclavicular brachial plexus block by ultrasonographic assessment. Acta Anaesthesiol Taiwanica. 2007;45:27-32.
35. Sauter AR, Smith HJ, Stubhaug A, Dodgson MS, Klaastad O. Use of magnetic resonance imaging to define the anatomical location closest to all three cords of the infraclavicular brachial plexus. Anesth Analg. 2006;103:1574-6.
36. Cornish PB, Nowitz M. A magnetic resonance imaging analysis of the infraclavicular region: can brachial plexus depth be estimated before needle insertion? Anesth Analg. 2005;100:1184-8.
37. Sinner B, Becke K, Engelhard K. Neurotoxicity of general anesthetics in childhood: does anesthesia leave its mark on premature babies, newborns and infants? Der Anaesth. 2013;62:91-100.
38. Olsen EA, Brambrink AM. Anesthetic neurotoxicity in the newborn and infant. Curr Opin Anaesthesiol. 2013;26:535-42.
39. Davidson AJ. Anesthesia and neurotoxicity to the developing brain: the clinical relevance. Paediatr Anaesth. 2011;21:716-21.
40. Leiner T, de Jong PA, Nievelstein RA. CT scans in children and adolescents: only when appropriate and when optimized. Ned Tijdschr Geneeskd. 2013;157:A6711.
41. Ruiz A, Sala X, Bargallo X, Hurtado P, Arguis MJ, Carrera A. The influence of arm abduction on the anatomic relations of infraclavicular brachial plexus: an ultrasound study. Anesth Analg. 2009;108:364-6.
42. Ecoffey C, Lacroix F, Giaufre E, Orliaguet G, Courreges P, Association des Anesthesistes Reanimateurs Pediatriques d'Expression F. Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Paediatr Anaesth. 2010;20:1061-9.
How to Cite
1.
Pérez-Pradilla AC, Pena-Riverón AA, Chaparro-Gómez LC, Castro-Ortiz LC, Velázquez-Delgado E, Acevedo-de la Peña R. Infraclavicular block in paediatric anaesthesia: Concordance between the modified Wilson approach and ultrasound in determining the ideal puncture site. Colomb. J. Anesthesiol. [Internet]. 2015 Oct. 1 [cited 2024 Apr. 19];43(4):269–277. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/330
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2015-10-01
How to Cite
1.
Pérez-Pradilla AC, Pena-Riverón AA, Chaparro-Gómez LC, Castro-Ortiz LC, Velázquez-Delgado E, Acevedo-de la Peña R. Infraclavicular block in paediatric anaesthesia: Concordance between the modified Wilson approach and ultrasound in determining the ideal puncture site. Colomb. J. Anesthesiol. [Internet]. 2015 Oct. 1 [cited 2024 Apr. 19];43(4):269–277. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/330
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