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Diwan, S; Feigl, G; Nair, A.
C5 ventral ramus block for clavicle surgery: How low concerning the volume can we go?
J ANAESTH CLIN PHARM. 2021; 37(4): 561-564. Doi: 10.4103/joacp.JOACP_362_20 [OPEN ACCESS]
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Co-authors Med Uni Graz: Feigl Georg
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Abstract:: Background and Aims: Clinical case reports mention 3-5 ml of local anesthetic (LA) at the cervical root 5 (C5) for surgical anesthesia essential for clavicle surgeries with reasonable success. A volume of 5 ml LA has been shown to cause hemidiaphragmatic paresis. Material and Methods: We implement the 3-5 ml LA for awake clavicle surgeries along with a supraclavicular nerve (SCN) block with another 2 ml. To understand the spread of injectate, we conducted anatomic macroscopic dissection on Theil based cadavers. Post ultrasound injection of 3 ml of blue latex in one cadaver and green latex in the other, we dissected one cadaver and the other cadaver underwent a cross-section. Results: Dissection confirmed a vertical spread of dye more caudad than cephalad. There was no neuraxial spread visualized in the cross-section. The phrenic nerve (PN) was not stained in both cadavers, but a possibility exists depending on its course. Conclusion: Based on this limited study we recommend a volume of LA of 3 ml at the level of C5 and another 2 ml at the level SCN of LA for clavicle surgeries.
Find related publications in this database (Keywords): Cadaver; cervical root; clavicle; phrenic nerve; regional anesthesia; supraclavicular nerve; ultrasonography