Name:
ACA- Hadzic- Peripheral Nerve Block 3e- Ultrasound-Guided Axillary Brachial Plexus Block 3
Description:
ACA- Hadzic- Peripheral Nerve Block 3e- Ultrasound-Guided Axillary Brachial Plexus Block 3
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/22d888da-f1c2-4c2c-a922-edc3aef20bb4/thumbnails/22d888da-f1c2-4c2c-a922-edc3aef20bb4.jpg?sv=2019-02-02&sr=c&sig=DgOKosomP58F7sc2DgVF0XGXTdh30TmAS8D%2BbXfFdng%3D&st=2022-07-03T18%3A27%3A26Z&se=2022-07-03T22%3A32%3A26Z&sp=r
Duration:
T00H03M42S
Embed URL:
https://stream.cadmore.media/player/22d888da-f1c2-4c2c-a922-edc3aef20bb4
Content URL:
https://asa1cadmoremedia.blob.core.windows.net/asset-5999b297-89e3-4836-b899-8c959f67c66d/ACA- Hadzic- Peripheral Nerve Block 3e- Ultrasound-Guided Ax.mov
Upload Date:
2022-02-23T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
DIGITAL INTRO TUNE:
DR. HADZIC: Now we're going to perform an axillary brachial plexus block in a patient having hand surgery. And for this block, the patient is usually in a supine position, and typically with the upper body slightly elevated. The superficial or external landmarks are also important, that's the axillary fossa crease. We never scan into the fossa. A sleeved ultrasound transducer is applied at the axillary fossa.
DR. HADZIC: So let us discuss what we have here in this image. This is the axillary artery. This is the axillary vein. This is an additional axillary vein inside the axillary brachial plexus. In here, we see the median nerve, the ulnar nerve. The insertion of this needle also allows us to determine the path or the angle at which the block needle needs to go.
DR. HADZIC: The needle here is inserted from the cephalad to the caudad. So we could see how the needle entered inside the brachial plexus sheath and it's positioned now between the median and the ulnar nerve. This is where the first aliquot of 8 mL of local anesthetic is injected. Okay, so we can see the spread of the local anesthetic inside the brachial plexus sheath and anytime when the local anesthetic spread is not seen inside the sheath, we would abandon the injection immediately because that would mean that the local anesthetic could be intravascular.
DR. HADZIC: At each instance, we have detected that there was no motor response, and at each instant, the injection pressure was lower than 20 psi because using the nerve guard, we have limited, or we are limiting the injection force to 20 psi. And now we have to block the musculocutaneous nerve which is outside of the brachial plexus sheath. To do that, the transducer is slightly raised proximally or cephalad, and the needle is directed in a steeper fashion to enter the space between the fascia sheaths of the biceps and the coracobrachialis.
DR. HADZIC: We do not inject around the nerves, but rather we inject into the tissue planes that contain the nerves and then open up the tissue space in order to accomplish local anesthetic spread within the tissue space that contains the nerves. So here's what we see on the image, we see the conjoint tendon, see the brachial plexus sheath that has been now distended.
DR. HADZIC: That is now the median nerve on top of the axillary artery. That is the ulnar nerve and that's the radial nerve. And we can see that all of these nerves are now invalid by the local anesthetic. And here is the musculocutaneous nerve, we can see where the fascia of the biceps and the coracobrachialis muscles are now separated to block the musculocutaneous.
DIGITAL OUTRO TUNE:
