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Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks

[Les septa peuvent influencer la diffusion de l’anesthésique local durant les blocs infraclaviculaires du plexus brachial]

From the Department of Anesthesiology, NYU Medical Center, New York, New York, USA.

Address correspondence to: Dr. Maki Morimoto, NYU Medical Center – Department of Anesthesiology, 560 First Avenue, New York, NY 10016, USA. Phone: 212-263-5072; Fax: 212-263-4366; E-mail: maki.morimoto{at}med.nyu.edu

Purpose: To ultrasonically identify the presence of septae within the neurovascular sheath and to assess their effect on local anesthetic spread when performing infraclavicular brachial plexus blocks.

Clinical features: Thirty ASA status I and II patients scheduled for minor hand surgeries were enrolled in the study. Ultrasound guided infraclavicular brachial plexus blocks were performed on 28 patients. The images of the local anesthetic spread and the effect of the septum within the neurovascular sheath were analyzed. Septae were present in four of six patients where unilateral local anesthetic spread was seen. Septae were not visualized in the 22 patients with unrestricted local anesthetic spread after the initial injection. All 28 patients underwent their planned operations successfully with adequate anesthesia.

Conclusions: Our study shows that the presence of septae within the neurovascular sheath may influence the pattern of local anesthetic spread associated with the infraclavicular approach to brachial plexus blocks.

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