Canadian Journal of Anesthesia, Vol 6, 32-39, Copyright © 1959 by Canadian Anesthesiologists' Society

The Short-Needle Technique in Brachial Plexus Block

¹ Department of Anaesthesia, Notre Dame Hospital, and Queen Mary Veterans' Hospital, Montreal, P.Q.

In the hope of reducing the incidence of pneumothorax associated with brachial plexus block anaesthesia, a short-needle technique, using the supra-clavicular approach, is described and the results in 82 cases are analysed.

Rather than use a mobile marker on a long needle shaft, the short needle is preferred as a safety precaution. The penetration of the short needle is necessarily limited to its length when the shank impinges upon the depressed skin surface. A -in., 24-gauge needle was used in the majority of cases. Since the success of the short-needle technique depends on causing the brachial plexus bundle to come as close as possible to the supraclavicular skin surface, special recommendations with regard to posturing of the patient are given.

The anaesthetist performs the block while standing at the head of the table behind the shoulder of the patient, on the side to be blocked.

The only criterion for a properly placed needle is paraesthesia, and the first rib is never sought as a deep landmark. Contact of the first rib with the needle is considered a hazard and an accident.

The short needle makes it possible to locate paraesthesias rapidly without fear of penetrating the pleura. Quick needle thrusts are made and the nerves of the brachial plexus are easily transfixed by the short, sharp, rapidly moving needle. The nerves are more likely to roll off from the path of a longer, larger gauge needle which is advanced cautiously and slowly.

An average of 24.5 cc. of a 1 per cent Xylocaine solution was used. The entire volume of solution is injected at the spot where paraesthesias are felt.

Complete anaesthesia developed rapidly in 75 patients. Delayed onsets were classified as failures. Absence of paraesthesias was also included in the failures although infiltration was not attempted in these cases. This accounts for the relatively high failure rate of 8.5 per cent.

An attempt was made to accelerate onset of anaesthesia by the application of ultrasound in eight patients. No definite conclusions were reached regarding the diffusion of anaesthetic solutions by ultrasound.

There were no pneumothoraces or other serious immediate or late complications.

The anaesthetist is cautioned against the possibility of needle breakage.

Advantages of the short-needle technique are set forth in the discussion. It is pointed out that practical training in brachial plexus block anaesthesia is greatly facilitated by the short-needle technique.

Note:

Presented at the Annual Meeting of the Canadian Anaesthetists' Society, June 23–25, 1958.

This article has been cited by other articles:

				S. R. Williams, P. Chouinard, G. Arcand, P. Harris, M. Ruel, D. Boudreault, and F. Girard Ultrasound Guidance Speeds Execution and Improves the Quality of Supraclavicular Block Anesth. Analg., November 1, 2003; 97(5): 1518 - 1523. [Abstract] [Full Text] [PDF]