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LETTERS TO EDITOR
Year : 2023  |  Volume : 17  |  Issue : 1  |  Page : 137-138

Modified supraclavicular brachial plexus block for humerus fracture surgery: A report of two cases


1 Department of Anesthesiology and Intensive Care, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey; Morphological Madrid Research Center (MoMaRC), UltraDissection Spain EchoTraining School, Madrid, Spain
2 Morphological Madrid Research Center (MoMaRC), UltraDissection Spain EchoTraining School, Madrid, Spain; Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey

Correspondence Address:
Berna Caliskan
Haseki Training and Research Hospital, Ugur Mumcu, Sultangazi, İstanbul

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.sja_508_22

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Date of Submission09-Jul-2022
Date of Acceptance10-Jul-2022
Date of Web Publication02-Jan-2023
 


How to cite this article:
Caliskan B, Altinpulluk EY. Modified supraclavicular brachial plexus block for humerus fracture surgery: A report of two cases. Saudi J Anaesth 2023;17:137-8

How to cite this URL:
Caliskan B, Altinpulluk EY. Modified supraclavicular brachial plexus block for humerus fracture surgery: A report of two cases. Saudi J Anaesth [serial online] 2023 [cited 2023 Feb 1];17:137-8. Available from: https://www.saudija.org/text.asp?2023/17/1/137/364865



To the editor,

Brachial plexus nerve block strategies for pain relief after upper extremity surgeries are highly advised for their long-proven benefits for the patient's overall well-being. Besides, it seems essential to improve safety along with concerns of effectivity by modifying block performance on the basis of anatomical considerations. In this paper, we describe two cases who received modified supraclavicular brachial plexus block for analgesia after proximal humerus surgery. Written informed consent was obtained from the patients for the procedure and publication.

Two patients were admitted with proximal humerus fracture (near type-3 fracture), and osteosynthesis with plaque was applied as surgery under general anesthesia. Before awakening, ultrasound-guided supraclavicular brachial plexus block was performed with the modified technique [Figure 1]. Until postoperative 48th hours, the patients never complained of pain (visual analog scale (VAS) = 0; verbal rating scale (VRS) = none), and later they were given rescue analgesia (VAS: 4; VRS = mild) just once during their hospital stay. We encountered no side effects with high patient satisfaction.
Figure 1: Modified supraclavicular brachial plexus block; SA = subclavian artery, BP = brachial plexus

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Anatomical difficulties (such as the short neck, clavicle localized with a higher angle than normal) or variations can make visualization of the brachial plexus challenging and have led anesthesiologists to find new block techniques.[1] Oliver-Fornies et al.[2] have recommended a modified ultrasound technique for supraclavicular brachial plexus block. Our cases were the first to report adequate analgesia with this new technique after humerus fracture surgery. We believe that successful and time-sparing results in these cases are due to facilitated visualization of the brachial plexus and sufficient needle space ensured with this modified technique. Due to 60° of cephalad needle localization and possible protection of pleura with visualization of Sibson's fascia, this technique may help avoid hemi diaphragmatic paralysis.

Although regional anesthesia after shoulder surgery had many comparisons and conclusions with enhanced patient outcomes, there is limited literature confirming these improvements in the surgical repair of proximal humerus fractures.[3] These cases illustrate the potential advantages of this modified posterior approach to a supraclavicular brachial nerve block to improve safety and practicality with effective analgesia after proximal humerus fracture surgery. More randomized controlled trials would be needed to reveal its efficacy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Feigl GC, Litz RJ, Marhofer P. Anatomy of the brachial plexus and its implications for the daily clinical practice: Regional anesthesia is applied anatomy. Reg Anesth Pain Med 2020;45:620-7.  Back to cited text no. 1
    
2.
Oliver-Fornies P, Morales KE, Fajardo-Pérez M, Salazar-Zamorano CH, Yamak-Altinpulluk E, Vilches LV, et al. Modified supraclavicular approach to brachial plexus block. J Clin Anesth 2022;76:110585.  Back to cited text no. 2
    
3.
Iliaens J, Metsemakers W-J, Coppens S, Hoekstra H, Sermon A, Van de Velde M, et al. Regional anaesthesia for surgical repair of proximal humerus fractures: A systematic review and critical appraisal. Arch Orthop Trauma Surg 2019;139:1731-41.  Back to cited text no. 3
    


    Figures

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