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| Ultrasound Innovation Award |
| Online Abstract Submission |
| (Author: Atul Gaur ) |
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| Abstract |
| Type: New block technique |
| Title: Supraclavicular Brachial Plexus Block in Lateral Position |
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| Disclosure Statements |
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My research & development of my invention is not supported by a commercial company |
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| Abstract |
| Introduction of real time ultrasound guidance to the regional anaesthesia has revived the supraclavicular brachial plexus approach for brachial plexus block enabling us, once again, to enjoy the associated advantages. Traditionally this block is performed while patient is laying supine, head turned to the contra lateral side with or without slight head up tilt. I describe a supraclavicular approach for brachial plexus block while patient is on his side with block side up.
All routine precautions, patient preparation and block procedure including the ultrasound system, needle, local anaesthetics etc. remain same as we otherwise follow while instituting ultrasound guided supraclavicular brachial plexus block. Patient is positioned laterally with side to be block up. The lateral position of patient offers the following advantages.
1. Awake patient can watch the procedure on ultrasound system and feels more secure and engaged.
2. The Operator, site of injection, line of needle insertion and ultrasound machine all are in same line hence aligned optimally to improve the block procedure and operator’s comfort.
3. The airway is easy to manage/stabilize in lateral position when procedure is performed under general anaesthesia.
4. The ultrasound probe can be moved freely in anterior, posterior and lateral directions in order to obtain optimal scan of brachial plexus. The probe is placed in sagital or oblique sagital plane as shown in video. Also the probe angle and tilt can be maximized medially or laterally when needed. Lateral position offers more freedom to obtain a safe plane of scan for needle trajectory as the probe can be easily moved away from the vital structures like thyrocervical trunk, pleura etc.
5. Adequate space is available on the posterior side of probe and patient for probe and needle maneuvering. This allows enough room to insert nerve block catheter through needle when required.
Placing patient in lateral position makes the block procedure simple, safe and convenient both for the patient and operator. The author has already presented this technique as a poster in past describing it as ‘Supraclavicular brachial plexus block in lateral position - Gaur approach’.
Also, the combi-tech needling procedure is described. It is often observed that while inserting the nerve block needle using in line needling technique, operator fails to locate the needle initially, more so in their learning curve. The combi-tech needling enhances the safety of needling as the nerve block needle is steered in deeper plane only under ultrasound guidance.
Optimal scan of the brachial plexus for nerve block is obtained. A little pressure is applied on to the over-lying skin with the help of ultrasound probe. The ultrasound probe is lifted off the skin. This creates a rectangle blanched area. The needle is inserted right in the centre of this rectangle as shown in external video for about half or two third of the length of the rectangle. Now the ultrasound probe is replaced over the needle. The probe is adjusted so as to visualize the needle and the brachial plexus. Afterwards the needle is steered in deeper planes under ultrasound guidance to deposit local anaesthetics. This technique is known as combi-tech as this is a combination of landmark (rectangle) and ultrasound guided technique.
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| Clinical Significance |
| Ultrasound guided Supraclavicular brachial plexus block in lateral position is technically easy to perform and offers a few advantages which enhances the safety issue. Combi tech needling procedure further enhances the safety of ultrasound guided procedure as the needle is steered in deeper planes only under ultrasound guidance hence should avoid injury to adjacent structures while attempting to locate the needle during in-line needling. |
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| Ultrasound Equipment |
| Manufacturer: GE Healthcare Ultrasound System |
| Model: Logiq e |
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| Probe Used |
| Type: Linear |
| Size: 12L-RS |
| Frequency: 8-13 MHz |
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| Files |
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1. Filename: GaurLateral1.wmv
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