Recently performance of peripheral regional blockade under control of ultrasound finds the increasing application in anesthesiology practice. It is connected with what allows to visualize directly structures which are subject to anesthetic influence, to control extent of their irrigation by local anesthetic, to considerably lower a necessary dose of drug and also to somewhat lower number of complications of conduction blockade.
Anesthesia of the upper extremity is widely used when carrying out traumatologic operations, in purulent surgery, in microsurgery. Regional anesthesia of the upper extremity is much more widely applied than anesthesia lower that is connected with distribution of spinal anesthesia. Ultrasound when carrying out blockade can be used both in monooption, and in combination with a neurostimulator. The last option is more preferable and is recommended by authoritative associations in the field of regional anesthesia now.
Regional anesthesia of a brachial plexus at various levels and also blockade of separate nerves of the lower extremity can be used.
If to speak about blockade of a brachial plexus, then now it is the most widespread option of regional anesthesia of the upper extremity. Allocate four accesses for blockade of a brachial plexus: interladder, supraclavicular, subclavial and axillary. Each of them in the best way anesthetizes only certain area of a shoulder girdle and the upper extremity therefore they do not replace each other and for each of these blockade there are indications.
Are necessary for carrying out anesthesia: the device ultrasonography with the linear sensor, a neurostimulator, needles for carrying out blockade, connecting tubes (for connection of a needle with the syringe and ensuring its immovability when carrying out blockade), a sterile table, balls, napkins, special sterile sleeves for the sensor. Manipulation is carried out in strictly aseptic conditions, with observance of all rules of sterility.
Interladder blockade is applied to clavicle and shoulder joint operations and also in certain areas of a shoulder. The patient is in a semi-sedentary position, the head is turned to the opposite side from blockade. For identification of a brachial plexus the ultrasonic sensor is placed in an interladder interval (between front and average scalenes). Placement of the sensor in supraclavicular area and identification of nervous structures of a texture is possible there then the sensor is advanced above before identification of trunks of a brachial plexus. After identification of a texture to it advance a needle in the sensor plane from the lateral party in the direction of the lower trunks of a texture. Enter necessary amount of local anesthetic. The needle is taken.
Supraclavicular blockade is applied to an elbow joint, forearm operations and a brush. The patient is in a semi-sedentary position, the head is turned to the opposite side from blockade. For identification of a brachial plexus the ultrasonic sensor is placed over a clavicle, identifying a subclavial artery, a pleura, the first edge and actually brachial plexus which is located near a subclavial artery. After identification of a texture to it advance a needle in the sensor plane from the lateral party in the direction of the lower part of a texture. Enter necessary amount of local anesthetic. Then the needle is redirected and enter anesthetic over the top part of a texture. The needle is taken.
Subclavial blockade is applied to an elbow joint, forearm operations and a brush. The head of the patient is turned to the opposite side from blockade, the hand is taken away and is at right angle in relation to a body axis. For identification of a brachial plexus the ultrasonic sensor is placed over a clavicle lateralno, in the parasagittal plane, identifying an axillary artery and a brachial plexus. After identification of a texture to it advance a needle in the sensor plane from the cranial party and enter anesthetic, trying to surround with it an artery. The needle is taken.
Axillary blockade is applied to forearm operations and a brush. The head of the patient is turned to the opposite side from blockade, the hand is taken away and is at right angle in relation to a body axis. For identification of a brachial plexus the ultrasonic sensor is placed in axillary area, perpendicular to an axis of the upper extremity, identifying an axillary artery and around it nerves of a brachial plexus. The needle is advanced in the sensor plane from the cranial party and enter anesthetic, trying to surround with it an artery. In addition enter anesthetic to a musculocutaneous nerve. The needle is taken.