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Subcoracoid tunnel block as an alternative infraclavicular brachial plexus approach -a case series-

대한마취과학회지 2020년 73권 5호 p.450 ~ 454
Diwan Sandeep, Sethi Divya, Gaikwad Avinash, Sancheti Parag Kantilal, Nair Abhijit,
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 ( Diwan Sandeep ) - Sancheti Institute of Orthopedics and Rehabilitation Department of Anesthesiology
 ( Sethi Divya ) - Employees’ State Insurance Cooperation Postgraduate Institute of Medical Sciences and Research Department of Anesthesia
 ( Gaikwad Avinash ) - Sancheti Institute of Orthopedics and Rehabilitation Department of Anesthesiology
 ( Sancheti Parag Kantilal ) - Sancheti Institute for Orthopaedics and Rehabilitation Department of Orthopaedics
 ( Nair Abhijit ) - Basavatarakam Indo-American Cancer Hospital and Research Institute Department of Anesthesiology

Abstract


Background: Magnetic resonance neurography shows the brachial plexus cords in the subcoracoid tunnel beneath the pectoralis minor. With an ultrasound scan along the brachial line, the brachial plexus cords in the subcoracoid tunnel can be targeted using an in-plane needle approach. We describe this new approach to the infraclavicular block called the “subcoracoid tunnel block.”

Case: Twenty patients were administered with the ultrasound-guided subcoracoid tunnel block for the below-elbow surgery. The contact of the needle tip with cords was visible in all 20 patients. With neurostimulation, the posterior cord was identified in 11 (55%) and medial cord in 9 (45%) patients on the first needle pass. The subcoracoid tunnel block was successful in 16 patients (80%).

Conclusions: Our case series shows that the subcoracoid tunnel block is an excellent alternative technique for the infraclavicular block. Its advantages include better needle-cord visibility and easy identification of the brachial plexus cords.

키워드

Acute pain; Brachial plexus block; Local anesthetics; Magnetic resonance neurography; Postoperative pain; Ultrasonography

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