I have had this a couple of times for shoulder // arm orthopedic surgery and am quite impressed with the amount of pain relief it provides. I had almost zero pain post-op and got a bit of a giggle as my arm was completely paralyzed for 1-2 days after.
Thank you for making this high quality helpful video. I did notice that as opposed to this video the NYSORA video and website stated that needle should be placed within the brachial plexus sheath.
Excellent teaching video, particularly with respect to use of hydrodissection and avoiding violation of the plexus sheath. Comment on quantity of local anesthetic to use to improve chances of block success was greatly appreciated.
Enjoy all of your Videos. What block or blocks would you recommend for a patient having open surgery for a fractured patella where a fixator is to be used? Usually, surgery is associated with a painful recovery period.
@@regionalanesthesiology How do you decide on adductor canal vs. femoral nerve for knee procedures? I figured you would have said adductor canal for this one!
Hi guys, thanks for excellent video. If you use for example 30 ml LA, do you add adrenalin to your LA as well? Becasue it looks like a volume block, if you use 30 ml and I mean it as a prevention to LAST. Thx
Yes, we always use adrenalin with our local anesthetic when using these big volumes (30-40 ml)…as a way to reduce the peak plasma concentration from the vasoconstriction and also as an intravascular marker. Thanks for watching!!
Fab video as ever - just wondering what volume you typically use and of what percent ropivicaine and do you use half above and half below. I note Dr Albrecht's recent paper reckoning 37 vs 18mins onset time in his series for intra vs extrafascial supraclaviculars. Ive found longer in my practice although I think might be relying too heavily on motor block onset time rather than distinguishing from sensory block onset time in reckoning surgical readiness? Just wondering your thoughts?
can we performe blind supraclavicular block in resource limited areas? if yes what are the techniques that we have to follow? you videos are amaizing ,thank you !
We used to do the supraclav approach with nerve stimulation (feel the subclavian pulse right above the clavicle and insert needle immediately lateral, aiming for first rib). There are some that did that approach without stimulation and just aimed to hit the first rib and then inject. So, it certainly CAN be done. However, if it were me in a resource limited environment, I would do an axillary brachial plexus block. It’s very safe, no risk of pneumothorax, effective. The transarterial approach requires just needle, syringe and a short length of tubing. If you have a nerve stimulator, that’s even better and you can elicit a twitch for each of the nerves. Thanks for watching and good luck!!
One thing I would like to mention, which for some reason in all videos are lacking. The depth- ajust the dept 3 cm for average person of 170-180 lb. Introduce the needle paralel to the clavicle and way ( 2 to 3cm) from the transducer. The goal is, the needle not to go toward the pleura and the needle to be visulized better ( paralel to the clavicle means paralel to the US beam and better visualization). Never every advance the needle "blindly". Always have a perfect visualization of the needle, ALWAYS in this block, have your dopler ON. Too many vessels there to take a risk. good luck...
They are virtually indistinguishable...so the reason for why you'd choose infra vs. supra becomes personal preference, comfort, and sometimes patient factors such as obesity or large pec muscles (which can make infra somewhat challenging) or the presence of arteries in the supraclavicular brachial plexus that might make infraclavicular a safer option. Always good to have multiple arrows in your quiver! 🏹
I have had this a couple of times for shoulder // arm orthopedic surgery and am quite impressed with the amount of pain relief it provides. I had almost zero pain post-op and got a bit of a giggle as my arm was completely paralyzed for 1-2 days after.
That is a beautiful block, with excellent technique. Very nice!
Great video. Great block.
Thank you for making this high quality helpful video. I did notice that as opposed to this video the NYSORA video and website stated that needle should be placed within the brachial plexus sheath.
@@regionalanesthesiology Thank you for your response and thoughtful editorial!
I was wondering the same
I was wondering the same
EXCELLENT VIDEO
Excellent 😊😊😊
Thanks
Nice video .. thank u
Excellent teaching video, particularly with respect to use of hydrodissection and avoiding violation of the plexus sheath. Comment on quantity of local anesthetic to use to improve chances of block success was greatly appreciated.
Excellent video and information about not violating the sheath...I see they do violate all the time...
0.5 ropi or bupivacaine will get you a surgical block and add epi to prevent intravascular spread
Amazing demo
Thanks!!
Is there grading for upper limb blocks for sensory and motor onset (like modified bromage scale for lower limbs)?
Enjoy all of your Videos. What block or blocks would you recommend for a patient having open surgery for a fractured patella where a fixator is to be used? Usually, surgery is associated with a painful recovery period.
@@regionalanesthesiology How do you decide on adductor canal vs. femoral nerve for knee procedures? I figured you would have said adductor canal for this one!
Wondering how long it takes for this method of not entering the sheath to work?
Hi guys, thanks for excellent video. If you use for example 30 ml LA, do you add adrenalin to your LA as well? Becasue it looks like a volume block, if you use 30 ml and I mean it as a prevention to LAST. Thx
Yes, we always use adrenalin with our local anesthetic when using these big volumes (30-40 ml)…as a way to reduce the peak plasma concentration from the vasoconstriction and also as an intravascular marker. Thanks for watching!!
Fab video as ever - just wondering what volume you typically use and of what percent ropivicaine and do you use half above and half below. I note Dr Albrecht's recent paper reckoning 37 vs 18mins onset time in his series for intra vs extrafascial supraclaviculars. Ive found longer in my practice although I think might be relying too heavily on motor block onset time rather than distinguishing from sensory block onset time in reckoning surgical readiness? Just wondering your thoughts?
Could you link the paper, please? Many thanks
Top 🔝
can we performe blind supraclavicular block in resource limited areas? if yes what are the techniques that we have to follow?
you videos are amaizing ,thank you !
We used to do the supraclav approach with nerve stimulation (feel the subclavian pulse right above the clavicle and insert needle immediately lateral, aiming for first rib). There are some that did that approach without stimulation and just aimed to hit the first rib and then inject. So, it certainly CAN be done. However, if it were me in a resource limited environment, I would do an axillary brachial plexus block. It’s very safe, no risk of pneumothorax, effective. The transarterial approach requires just needle, syringe and a short length of tubing. If you have a nerve stimulator, that’s even better and you can elicit a twitch for each of the nerves. Thanks for watching and good luck!!
How do you block Intercostobrachial Nerve?
By ring block...
One thing I would like to mention, which for some reason in all videos are lacking. The depth- ajust the dept 3 cm for average person of 170-180 lb. Introduce the needle paralel to the clavicle and way ( 2 to 3cm) from the transducer. The goal is, the needle not to go toward the pleura and the needle to be visulized better ( paralel to the clavicle means paralel to the US beam and better visualization). Never every advance the needle "blindly". Always have a perfect visualization of the needle, ALWAYS in this block, have your dopler ON. Too many vessels there to take a risk. good luck...
is supraclavicular and infraclavicular block coverage different?
They are virtually indistinguishable...so the reason for why you'd choose infra vs. supra becomes personal preference, comfort, and sometimes patient factors such as obesity or large pec muscles (which can make infra somewhat challenging) or the presence of arteries in the supraclavicular brachial plexus that might make infraclavicular a safer option. Always good to have multiple arrows in your quiver! 🏹
@@regionalanesthesiology thank you for your insight doc
Your probe positioning comment is poorly worded. Listen again at 1:55
Made perfect sense to me with the video demonstrating what to do