Optimization of ultrasound navigation techniques for brachial plexus block using proximal subclavian access

BACKGROUND: when performing a brachial plexus block in the proximal subclavian region, the scanning plane is located deeper and posterior to the midpoint of the clavicle. There are limited data evaluating the angle of the ultrasound probe and the visualization of the brachial plexus bundles.

AIMS: evaluate visualization and positioning of the neurovascular bundle in the infraclavicular region for proximal brachial plexus block.

MATERIALS AND METHODS: the study was performed on volunteer patients at the Military Traumatology and Orthopedics Clinic of the Military Medical Academy named after. CM. Kirov.

RESULTS: during the study, it was noted that the best visualization of the brachial plexus bundles is observed at an average sensor angle of between 900 and the maximum that allows visualization of at least one of the elements of the brachial plexus 64.40 (65.70, 630) and amounted to 77.50 (77 .90, 76.50).

CONCLUSIONS: the optimal angle for performing a brachial plexus block using the proximal subclavian approach is 77.50. Optimal visualization of the brachial plexus is possible in the angle range from 900 to 64.40, which allows, when performing a blockade in this area, to select the safest trajectory of the needle, taking into account the anatomical characteristics of the patient. Further studies are needed to compare the sensor angles used in actual clinical practice with the angles obtained in our study.