Biomedical subjects
Publications and source records attributed to P B Cornish.
Peripheral nerve catheters are being used increasingly to manage acute pain. Whilst acknowledged as effective, their broader implications for patient outcome are less clear. In this case report, we describe the way in which not only was the pain management of an ischaemic leg successful via a sciatic nerve catheter, but decision-making around this strategy affected outcome.
A new technique for achieving brachial plexus anaesthesia through the supraclavicular fossa is described. Its objectives are to minimize risk to the lung and provide for continuous as well as single-shot options. The plexus is approached through the lateral aspect of the supraclavicular fossa, and a bend in the shaft of the needle permits the tip of the needle to be directed tangential to the chest wall. An audit of 572 cases associated with the development of this technique is presented.
UNLABELLED: Supraclavicular nerve blocks are effective but may be complicated by pneumothorax. We hypothesized that, to avoid this complication, the depths of the brachial plexus and the lung could be estimated to guide needle placement. In 17 patients undergoing surgical relief of thoracic outlet syndrome, we designated a point on the skin midway between the clavicle and the trapezius muscle, in line with the most lateral point of the arterial pulsation in the supraclavicular fossa, to make preoperative height measurements relative to the clavicle and then intraoperative depth measurements of the plexus, artery, and pleura. The height of the reference point above the top of clavicle did not differ significantly from the depth of the plexus. The height of the reference point above the top, middle, and bottom of the clavicle differed significantly from the pleural depth (P = 0.0001, P = 0.0001, P = 0.0005, respectively). Patient weight correlated significantly with the depth of the plexus (P = 0.004, r2 = 0.45), artery (P = 0.0003, r2 = 0.42), and pleura (P = 0.0003, r2 = 0.58). We conclude that it is possible to accurately estimate the depth of the brachial plexus in the supraclavicular fossa. IMPLICATIONS: In this study, we sought to minimize the risk of pneumothorax when approaching the brachial plexus through the supraclavicular fossa by developing a technique that could accurately estimate the depth of the nerves, within a range that is well clear of the lung.
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