| Autor: |
William F. Urmey |
| Rok vydání: |
2008 |
| Předmět: |
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| Zdroj: |
European Journal of Pain Supplements. 2:36-39 |
| ISSN: |
1754-3207 |
| DOI: |
10.1016/s1754-3207(08)70062-2 |
| Popis: |
Present technological advances allow more accurate needle/catheter placement. Continuous regional analgesia with perineural catheters has been shown to significantly improve outcome. Grossi introduced the “anesthetic line” concept as a guide for approaches to perineural regional anesthesia. Winnie introduced the concept of the brachial plexus sheath that envelops the neural or neurovascular plexus. He discussed similar sheathes applying to the lower extremity. Recent studies support his sheath theory. Anatomical as well as local anesthetic distribution studies support a new concept that has relevant clinical applications. This concept is the presence of an anatomical impingement point at the junction of the clavicle and first rib that acts as a functional point of resistance to the flow of an injectate beyond this point. Similarly, it restricts the advancement of a catheter. The brachial plexus should be thought of as an hourglass-shaped anatomical compartment with the narrow portion of the hourglass at the costoclavicular junction. Above the clavicle the compartment is triangular and flat. Below the clavicle a larger cylindrical half-hourglass shape prevails. Injections above and or below the clavicle lead to different anesthetic distributions as well as clinical results. This anatomy will continue to be elucidated and must be kept in mind when targeting anesthesia or analgesia by single or multiple injections and for optimal placement of catheter or catheters for continuous infusions. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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