[Ultrasound-guided costoclavicular block as an alternative for upper limb anesthesia in obese patients]
Grazielle Rodrigues Silva, Danielle Gonçalves Borges, Iuri Ferreira Lopes, Roberto Araújo Ruzi, Paulo Ricardo Rabello de Macedo Costa, Beatriz Lemos da Silva Mandim, Grazielle Rodrigues Silva, Danielle Gonçalves Borges, Iuri Ferreira Lopes, Roberto Araújo Ruzi, Paulo Ricardo Rabello de Macedo Costa, Beatriz Lemos da Silva Mandim
Abstract
Background and objectives: Costoclavicular brachial plexus block is an anesthesia performed through the infraclavicular route described in the literature as a safe and effective route for upper limb anesthesia distal to the elbow. The following report describes the case of a patient whose traditional plexus blocking techniques presented ultrasound visualization difficulty, but the costoclavicular approach was easy to visualize for anesthetic blockade.
Case report: A grade 3 obese patient scheduled for repair of left elbow fracture and dislocation. Ultrasound examination revealed a distorted anatomy of the supraclavicular region and the axillary region with skin lesions, which made it impossible to perform the blockade in these regions. It was decided to perform an infraclavicular plexus block at the costoclavicular space, where the brachial plexus structures are more superficial and closer together, supported by a muscular structure, lateral to all adjacent vascular structures and with full view of the pleura. The anesthetic block was effective to perform the procedure with a single injection and uneventfully.
Conclusion: Costoclavicular brachial plexus block is a good alternative for upper limb anesthesia distal to the elbow, being a safe and effective option for patients who are obese or have other limitations to the use of other upper limb blocking techniques.
Keywords: Anestesia regional; Bloqueio do plexo braquial; Brachial plexus block; Costoclavicular; Obesidade; Obesity; Regional anesthesia; Ultrasound; Ultrassonografia.
Copyright © 2019 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.
Figures
References
- Bluth T., Pelosi P., de Abreu M.G. The obese patient undergoing nonbariatric surgery. Curr Opin Anaesthesiol. 2016;29:421–429.
- Brodsky J.B., Mariano E.R. Regional anaesthesia in the obese patient: lost landmarks and evolving ultrasound guidance. Best Pract Res Clin Anaesthesiol. 2011;25:61–72.
- Sala-Blanch X., Reina M.A., Pangthipampai P., et al. Anatomic basis for brachial plexus block at the costoclavicular space: a cadaver anatomic study. Reg Anesth Pain Med. 2016;41:387–391.
- Li J.W., Songthamwat B., Samy W., et al. Ultrasound- guided costoclavicular brachial plexus block: sonoanatomy, technique, and block dynamics. Reg Anesth Pain Med. 2017;42:233–240.
- Karmakar M.K., Sala-Blanch X., Songthamwat B., et al. Benefits of the costoclavicular space for ultrasound-guided infraclavicular brachial plexus block: description of a costoclavicular approach. Reg Anesth Pain Med. 2015;40:287–288.
- Berde C.B., Strichartz G.R. In: Miller's anesthesia. 8th ed. Miller R.D., et al., editors. Elsevier; Philadelphia: 2015. Local Anesthetics; pp. 1040–1041. [chapter 36]
- Franco C.D., Gloss F.J., Voronov G., et al. Supraclavicular block in the obese population: an analysis of 2020 blocks. Anesth Analg. 2006;102:1252–1254.
- Sotthisopha T., Elgueta M.F., Samerchua A., et al. Minimum effective volume of lidocaine for ultrasound-guided costoclavicular block. Reg Anesth Pain Med. 2017;42:571–574.
Source: PubMed