Critical structures in the needle path of the costoclavicular brachial plexus block: a cadaver study.

PURPOSE: The costoclavicular block is a relatively novel alternative to the infraclavicular block. We aimed to determine the anatomical structures vulnerable to needle injury during a costoclavicular block. METHODS: The needle path consistent with a costoclavicular block approach was performed bilaterally on four lightly embalmed cadavers using ultrasound guidance. Careful dissection was performed with 18-G Tuohy needles in situ and photographs were taken. RESULTS: The needle penetrated the deltoid in six of eight cases and the pectoralis minor in three of eight cases. The subclavius tendon or its fascia were punctured in two of eight cases. The lateral cord was in contact with the needle in six procedures and punctured in three. The posterior cord was contacted in two instances, and the medial cord in one. In a single dissection, the needle was in contact with the medial antebrachial cutaneous nerve. The needle was close to the medial brachial cutaneous nerve in one case and close to the pectoral nerves in two of eight cases. While the cephalic vein and thoracoacromial artery were consistently nearby, there were no cases of vascular puncture. CONCLUSION: We found that the needle path may be close to the medial antebrachial cutaneous nerve, medial brachial cutaneous nerve, and pectoral nerves but did not traverse any critical structures aside from the lateral cord. This suggests relative safety when compared with other approaches to the infraclavicular brachial plexus. Structures dans la trajectoire de l'aiguille du bloc de plexus brachial costoclaviculaire : une étude cadavérique.

RéSUMé: OBJECTIF: Le bloc costoclaviculaire est une alternative relativement nouvelle au bloc infraclaviculaire. Notre objectif était de déterminer quelles structures anatomiques étaient vulnérables aux lésions provoquées par l'aiguille pendant un bloc costoclaviculaire MéTHODE: Nous avons simulé, sous échoguidage, une trajectoire d'aiguille correspondant à l'approche pour un bloc costoclaviculaire en bilatéral sur quatre cadavres légèrement embaumés. Une dissection minutieuse a ensuite été exécutée avec des aiguilles Tuohy 18-G laissées in situ et des photographies ont été prises. RéSULTATS: L'aiguille a pénétré le deltoïde dans six des huit cas et le muscle petit pectoral dans trois des huit cas. Le tendon sous-clavier ou son fascia ont été perforés dans deux des huit cas. Le cordon latéral a été en contact avec l'aiguille dans six interventions et perforé dans trois cas. Le cordon postérieur a été touché dans deux cas, et le cordon médial dans un cas. L'aiguille a touché le nerf cutané antébrachial médial dans une seule dissection. L'aiguille était proche du nerf cutané brachial médial dans un cas et proche des nerfs pectoraux dans deux des huit cas. Alors que la veine céphalique et l'artère thoraco-acromiale étaient toujours à proximité, il n'y a eu aucun cas de ponction vasculaire. CONCLUSION: Nous avons constaté que la trajectoire de l'aiguille peut être à proximité du nerf cutané antébrachial médial, du nerf cutané brachial médial et du nerf pectoral, mais l'aiguille n'a pas traversé de structures critiques hormis le cordon latéral. Ceci suggère l'innocuité relative de ce type de bloc par rapport à d'autres approches du plexus brachial infraclaviculaire.

The relationship between nicotine cessation and mental disorders in a nationally representative sample.

The objective of this study was to examine the relationship between Axis I and II mental disorders, quality of life, and nicotine dependence cessation in a nationally representative sample. Data came from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of adults in the United States (N = 34,653). People who met DSM-IV criteria for nicotine dependence previously but who had abstained from nicotine in the last year (nicotine cessation) were compared to people currently dependent on nicotine as well as lifetime abstainers using multivariate logistic regression. Outcomes of interest included DSM-IV Axis I and II mental disorders, treatment seeking for mental disorders, and quality of life measures. In adjusted models, individuals who ceased nicotine use in the last year were less likely to have past-year mood [adjusted odds ratio (AOR) = 0.64; 95% confidence interval (CI) 0.50-0.82, p < 0.001] and substance use disorders (AOR = 0.65, 95% CI 0.52-0.82, p < 0.001) compared to those with current nicotine dependence. They were also less likely to have narcissistic and borderline personality disorders. Compared to those with current nicotine dependence, cessation was associated with an improved quality of life, both physically (beta = 1.65; standard error 0.40, p < 0.001) and mentally (beta = 2.17, standard error 0.39, p < 0.001). In conclusion, nicotine dependence cessation was associated with reduced likelihood of several mental disorders and a higher quality of life compared to those with current nicotine dependence. These findings provide further support for public health policy aimed at smoking cessation.