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Ultrasound-guided selective trunk block (SeTB): a cadaver anatomic study to evaluate the spread of dye after a simulated injection
  1. Banchobporn Songthamwat1,
  2. Pobe Luangjarmekorn2,
  3. Wirinaree Kampitak1,
  4. Ranjith Kumar Sivakumar3 and
  5. Manoj Kumar Karmakar3
  1. 1Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
  2. 2Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  3. 3Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Faculty of Medicine, Shatin, New Territories, Hong Kong, SAR, China
  1. Correspondence to Professor Manoj Kumar Karmakar, Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Faculty of Medicine, Shatin, New Territories, Hong Kong, SAR, China; karmakar{at}cuhk.edu.hk

Abstract

Background and objectives Recent reports suggest that a selective trunk block (SeTB) can produce sensorimotor blockade of the entire upper extremity, except for the T2 dermatome. There are no data demonstrating the anatomic mechanism of SeTB. This cadaver study aimed to evaluate the spread of an injectate after a simulated ultrasound-guided (USG) SeTB.

Methods USG SeTB (n=7) was performed on both sides of the neck in four adult human cadavers with 25 mL of 0.1% methylene blue dye. Anatomic dissection was performed to document staining (deep, faint, and no stain) of the various elements of the brachial plexus from the level of the roots to the cords, including the phrenic, dorsal scapular, and long thoracic nerves. Only structures that were deeply stained were defined as being affected by the SeTB.

Results All the trunks and divisions of the brachial plexus, as well as the ventral rami of C5–C7 and suprascapular nerve, were deeply stained in all (100%) the simulated injections. The ventral rami of C8 and T1 (86%), dorsal scapular and long thoracic nerve (71%), and the phrenic nerve (57%) were also deeply stained in a substantial number of the injections.

Conclusion This cadaver study demonstrates that an USG SeTB consistently affects all the trunks and divisions of the brachial plexus, as well as the suprascapular nerve. This study also establishes that SeTB may not be phrenic nerve sparing. Future research to evaluate the safety and efficacy of SeTB as an all-purpose brachial plexus block technique for upper extremity surgery is warranted.

Trial registration number Registered at https://www.thaiclinicaltrials.org on December 13, 2021 under the trial registration number TCTR20211213005.

  • anatomy
  • analgesia
  • brachial plexus
  • ultrasonography

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Footnotes

  • Twitter @Ranjith_SRK

  • Contributors BS was involved with planning and design of study, data acquisition, review of the literature, review of data, data analysis, and preparation of the manuscript. PL was involved with data acquisition, review of the literature, review of data, and editing the manuscript. WK was involved with planning and design of study, review of the literature, review of the data, and editing the manuscript. RKS was involved with review of the literature, review of the data, editing the manuscript. MKK was involved with conception, planning and design of the report, review of the data, and preparation of the manuscript and is guarantor.

  • Funding This work was locally funded by Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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