Comparison of tissue distribution, phrenic nerve involvement, and epidural spread in standard- vs low-volume ultrasound-guided interscalene plexus block.

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Presentation transcript:

Comparison of tissue distribution, phrenic nerve involvement, and epidural spread in standard- vs low-volume ultrasound-guided interscalene plexus block using contrast magnetic resonance imaging: a randomized, controlled trial† O. Stundner, M. Meissnitzer, C.M. Brummett, S. Moser, R. Forstner, A. Koköfer, T. Danninger, P. Gerner, L. Kirchmair, G. Fritsch British Journal of Anaesthesia Volume 116, Issue 3, Pages 405-412 (March 2016) DOI: 10.1093/bja/aev550 Copyright © 2016 The Author(s) Terms and Conditions

Fig 1 Consolidated Standards of Reporting Trials (CONSORT) flow chart. British Journal of Anaesthesia 2016 116, 405-412DOI: (10.1093/bja/aev550) Copyright © 2016 The Author(s) Terms and Conditions

Fig 2 The incidence of anatomical spread outcomes as evidenced by magnetic resonance imaging for the Standard-volume (20 ml) and Low-volume (5 ml) Groups. There were no differences between the groups for the primary outcome, epidural spread; however, there was significantly less central and aberrant spread in the Low-volume Group. British Journal of Anaesthesia 2016 116, 405-412DOI: (10.1093/bja/aev550) Copyright © 2016 The Author(s) Terms and Conditions

Fig 3 (a) Transaxial T1 fast-field echo (FFE) chemical shift magnetic resonance (MR) image. Epidural spread can be seen, with local anaesthetic spread extending through the C5/C6 neuroforamen on the right to the spinal dura (white arrows). M, spinal medulla; *, cerebrospinal fluid space. (b) Transaxial T1 FFE chemical shift MR image. Local anaesthetic can be seen extending into the neurforamen C5/C6 on the left (white arrows), without epidural spread. M, spinal medulla; *, cerebrospinal fluid space. (c) Transaxial T1 FFE chemical shift MR image. Local anaesthetic can be seen distributing around the phrenic nerve on the right (long arrow) along its course anterior to the anterior scalene muscle (*). The short arrow depicts the brachial plexus. (d) Coronal T1 FFE chemical shift MR image. Extensive intramuscular spread of local anaesthetic (long arrows) can be seen within the anterior scalene muscle (*). C6 and C7, sixth and seventh cervical vertebral bodies. (e) Coronal T1 FFE chemical shift MR image. Minimal intramuscular spread of local anaesthetic (arrow) can be seen within the anterior scalene muscle (*). C6 and C7, sixth and seventh cervical vertebral bodies. British Journal of Anaesthesia 2016 116, 405-412DOI: (10.1093/bja/aev550) Copyright © 2016 The Author(s) Terms and Conditions