ABSTRACT
BACKGROUND: Axillary block is the most commonly performed brachial plexus block and may be guided by nerve stimulation or ultrasound. Magnetic resonance imaging (MRI) has proven to be beneficial in presenting anatomy of interest for regional anaesthesia and in demonstrating spread of local anaesthetic. The aim of this pilot study was to demonstrate the anatomy as shown by MRI of the brachial plexus in the axillary region. METHODS: Nine volunteers and nine patients were examined in a 3.0 Tesla MR. The patients had two different brachial plexus blocks. Subsequently, they were scanned by MRI and finally tested clinically for block efficacy before operation. Axial images, with and without local anaesthetics injected, were viewed in a sequence loop to identify the anatomy. RESULTS: With the high-resolution MRI, we obtained images of good quality, and cords and all terminal nerves could be identified. When local anaesthetics are injected, neurovascular structures are displaced, and the vein is compressed. Viewing the images in a sequence loop facilitates identification of the different nerves and has high instructive value (links S1-3 to these loops are enclosed). CONCLUSION: Clinical high-field 3.0 Tesla MRI scanner gives good visualization of brachial plexus in the axilla. The superior ability to detect local anaesthetics after it has been injected and the multiplanar imaging capability make MRI a useful tool in studies of the brachial plexus.
Subject(s)
Anesthetics, Local/pharmacology , Axilla/innervation , Brachial Plexus/anatomy & histology , Magnetic Resonance Imaging/methods , Nerve Block/methods , Anesthetics, Local/pharmacokinetics , Axilla/blood supply , Axillary Artery/ultrastructure , Axillary Vein/ultrastructure , Brachial Plexus/drug effects , Bupivacaine/pharmacokinetics , Bupivacaine/pharmacology , Humans , Injections , Mepivacaine/pharmacokinetics , Mepivacaine/pharmacology , Muscle, Skeletal/drug effects , Muscle, Skeletal/innervation , Pilot Projects , Pressure , Radial Nerve/ultrastructureABSTRACT
BACKGROUND: We have had favourable experience with a triple injection technique, combining an axillary catheter technique with a transarterial axillary block. This method has been used successfully for routine surgery and re-implantation of fingers, hand or forearm. We hypothesized that with this technique, block onset time and effectiveness are better than with a conventional catheter technique, and designed a study comparing this new technique with a conventional single injection through a catheter. METHODS: Fifty-one adult patients were included in a prospective study. In all patients, a short axillary plexus catheter was positioned close to the median nerve. All patients had an injection through the catheter, while 26 of the patients had an additional injection behind, and in front of, the axillary artery. Sensory and motor block were tested continuously every minute for 29 min. Block success was recorded as onset time to analgesia, anaesthesia and complete motor block in the first 29 min. At 30 and 50 min, an analgesia block score was recorded. RESULTS: The transarterial injection plus catheter method was more effective, with a higher success rate and faster onset, than the catheter method. Readiness for surgery with analgesia in the median, radial and ulnar nerves was achieved in the catheter group in 13 patients (52%) at a mean time of 20.8 min, and in the combined group in 21 patients (81%) at a mean time of 13.3 min (P<0.05, P<0.05). At 50 min the situation was 17 (68%) and 24 (92%), respectively (P<0.05). CONCLUSION: The combined triple injection is faster and more effective than the catheter method alone.
Subject(s)
Anesthetics, Local/administration & dosage , Axilla , Catheterization , Nerve Block/methods , Adult , Axillary Artery , Female , Humans , Injections , Male , Median Nerve , Nerve Block/adverse effects , Upper ExtremityABSTRACT
A case of a pheochromocytoma of the urinary bladder is reported which was treated preoperatively with alpha-receptor-blocking agents. The tumor was operated transurethrally, followed by partial cystectomy.
Subject(s)
Pheochromocytoma , Urinary Bladder Neoplasms , Combined Modality Therapy , Cystectomy , Humans , Male , Middle Aged , Phenoxybenzamine/therapeutic use , Pheochromocytoma/drug therapy , Pheochromocytoma/surgery , Urinary Bladder Neoplasms/drug therapy , Urinary Bladder Neoplasms/surgeryABSTRACT
The position of a central venous catheter has to be controlled. As a supplement to radiography of the chest the position of the catheter tip can be documented by means of ECG. The ECG is recorded with the catheter tip functioning as one of the electrodes. If the catheter tip is situated in the right atrium the ECG will record an elevated P-wave. When the catheter is pulled back into the vena cava superior the atrial-P will assume a normal shape. The position of the catheter tip correlates with the morphology of the P-wave. An ECG recording performed during insertion of the catheter can be used to achieve correct positioning of the catheter to start with and thereby reduce the frequency of having to replace wrongly positioned catheters. Intraoperatively the ECG recording is a practical method of achieving correct and extracardial placement of the catheter tip.
