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Brief technical report
Upper trunk block for shoulder analgesia with potential phrenic nerve sparing: a preliminary anatomical report
  1. José Cros Campoy1,
  2. Oscar Domingo Bosch2,
  3. Jaume Pomés3,
  4. Jing Lee2,
  5. Ben Fox4 and
  6. Xavier Sala-Blanch5,6
  1. 1 Anesthesia, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
  2. 2 Anesthesia, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
  3. 3 Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
  4. 4 Anaesthesia, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
  5. 5 Anesthesia, Hospital Clinic de Barcelona, Barcelona, Spain
  6. 6 Human Anatomy and Embriology, Universitat de Barcelona, Barcelona, Spain
  1. Correspondence to Dr Xavier Sala-Blanch, Anesthesia, Hospital Clinic de Barcelona, Barcelona 08036, Spain; xavi.sala.blanch{at}gmail.com

Abstract

Background and objectives Ipsilateral phrenic nerve palsy (PNP) is an undesirable side of conventional approaches to interscalene brachial plexus blocks. The purpose of this study was to demonstrate whether or not the phrenic nerve can be spared by dye when injected at the division of the upper trunk of the brachial plexus.

Methods Under ultrasound guidance, 5 mL of radiolabeled dye was injected between the anterior and posterior division of the upper trunk in two fresh, cryopreserved cadavers. CT scan analysis, cadaveric dissection, and cryosectioning were performed to examine the spread of the injectate.

Results We found staining of the injectate over the entire upper trunk with its anterior and posterior divisions, the suprascapular nerve under the omohyoid muscle and the lateral pectoralis nerve, and the C5 and C6 roots. The middle trunk was partially stained. There was no evidence of dye staining of the lower trunk, anterior aspect of the anterior scalene muscle, or the phrenic nerve.

Conclusions Our study offers an anatomical basis for the possibility of providing shoulder analgesia and avoiding a PNP.

  • interscalene block
  • nerve block
  • shoulder surgery
  • postoperative analgesia
  • ultrasound
  • anatomy

https://doi.org/10.1136/rapm-2019-100404

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    Footnotes

    • Presented at This article has been presented as an e-poster and oral presentation during the ESRA meeting, Dublin, 2018.

    • Contributors JCC participated in study design, conduction, data collection, data analysis, and manuscript preparation. Attestation: JCC approved the final manuscript. ODB participated in study conduction, data collection, data analysis, and manuscript preparation. Attestation: ODB approved the final manuscript. JP participated in data collection and data analysis. Attestation: JP approved the final manuscript. JL participated in study conduction and data collection, and manuscript preparation. Attestation: JL approved the final manuscript. BF participated in study conduction and data collection, and manuscript preparation. Attestation: BF approved the final manuscript. XS-B designed the study, participated in study conduction, data collection, data analysis, and manuscript preparation. Attestation: XS-B approved the final manuscript.

    • Funding The authors received internal funding from the Faculty of Medicine, Universitat of Barcelona, Spain, for this article.

    • Competing interests All authors have participated in the design and conduct of the study, have read and approved the document, they meet the requirements of authorship, have no conflicts of interest and consider the manuscript presents an honest work and have respected all ethical principles of the World Medical Association and the Declaration of Helsinki.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the Research Ethics Committee and conducted at the Medical School, University of Barcelona.

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