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Redefining Limits: Shoulder Disarticulation Under Regional Anaesthesia Alone

December 10, 2024/22 Comments/in Volume 5; Issue 2: July-December 2024/by Ijraijraadmin

Vol 5 | Issue 2 | July-December 2024 | Page 16-19| Vandana Mangal, Momoson Maring Tontanga, Chitra Singh, Tuhin Mistry DOI: https://doi.org/10.13107/ijra.2024.v05.i02.98 Open Access License: CC BY-NC 4.0 Copyright Statement: Copyright © 2024; The Author(s). Submitted: February 18-11-2024; Reviewed: 25-11-2024; Accepted: 02-12-2024; Published: 10-12-2024 Authors: Vandana Mangal [1], Momoson Maring Tontanga [1], Chitra Singh [1], […]

Brachial Plexus Block above the level of clavicle in Multi-Comorbid Patients with Difficult Surface Landmarks and Cervical Ankylosing Spondylosis

December 10, 2024/14 Comments/in Volume 5; Issue 2: July-December 2024/by Ijraijraadmin

Vol 5 | Issue 2 | July-December 2024 | Page 10-12| Nitin Gawai, Sandeep Diwan, Ganesh Bhong, Sunil Dixit, Parag Sancheti DOI: https://doi.org/10.13107/ijra.2024.v05.i02.94 Open Access License: CC BY-NC 4.0 Copyright Statement: Copyright © 2024; The Author(s). Submitted: February 18-07-2024; Reviewed: 12-09-2024; Accepted: 14-10-2024; Published: 10-12-2024 Authors: Nitin Gawai [1], Sandeep Diwan [1], Ganesh Bhong [2], […]

Redefining Limits: Shoulder Disarticulation Under Regional Anaesthesia Alone

December 10, 2024/22 Comments/in Volume 5; Issue 2: July-December 2024/by Ijraijraadmin

Brachial Plexus Block above the level of clavicle in Multi-Comorbid Patients with Difficult Surface Landmarks and Cervical Ankylosing Spondylosis

December 10, 2024/14 Comments/in Volume 5; Issue 2: July-December 2024/by Ijraijraadmin

Full Sized Blog Element (Big Preview Pic)

Redefining Limits: Shoulder Disarticulation Under Regional Anaesthesia Alone

December 10, 2024/22 Comments/in Volume 5; Issue 2: July-December 2024/by Ijraijraadmin

Vol 5 | Issue 2 | July-December 2024 | Page 16-19| Vandana Mangal, Momoson Maring Tontanga, Chitra Singh, Tuhin Mistry

DOI: https://doi.org/10.13107/ijra.2024.v05.i02.98

Open Access License: CC BY-NC 4.0

Submitted: February 18-11-2024; Reviewed: 25-11-2024; Accepted: 02-12-2024; Published: 10-12-2024

Authors: Vandana Mangal [1], Momoson Maring Tontanga [1], Chitra Singh [1], Tuhin Mistry [2]

[1] Department of Anaesthesiology and Critical Care, SMS Medical College, Jaipur, Rajasthan, India.
[2] Department of Anaesthesiology and Perioperative Care, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, India

Address of Correspondence

Dr. Tontanga Momoson Maring
Department of Anaesthesiology and Critical Care, SMS Medical College, Jaipur, Rajasthan, India.
Email id: drmomoson@gmail.com

Abstract

Shoulder disarticulation following of animal bites is not uncommon and is often performed for various indications, including vascular insufficiency. General anaesthesia is usually the preferred choice in optimized patients, with or without regional anaesthesia. Phantom limb pain is a distressing and frequently encountered condition following limb amputation. In addition to their well-established benefits, nerve blocks not only provide effective perioperative analgesia but may also reduce the incidence of phantom limb pain. In this case, we undertook shoulder disarticulation exclusively under regional anaesthesia, as the patient’s respiratory condition was not optimal for general anaesthesia.

Keywords: Shoulder disarticulation, Regional anaesthesia, Subclavian perivascular block, Superficial cervical plexus block, Pectoserratus plane block.

References

1. Mahajan, A., Luther, A., & Chhabra, A. (2015). Brachial artery injury caused by camel bite. Indian Journal of Vascular and Endovascular Surgery, 2(1), 33. https://doi.org/10.4103/0972-0820.152834
2. Abu-Zidan FM, Hefny AF, Eid HO, Bashir MO, Branicki FJ. Camel-related injuries: Prospective study of 212 patients World J Surg. 2012;36:2384–9
3. Maduri P, Akhondi H. Upper Limb Amputation. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK540962/
4. Donnelly, M. R., & Hacquebord, J. H. (2023). Shoulder level amputation: Forequarter and brachial plexus-level amputation. Operative Techniques in Orthopaedics, 33(3), 101056. https://doi.org/10.1016/j.oto.2023.101056
5. Kilicaslan A, Gok F, Colak TS, Keklicek O, Kucuksen MF. Combined interscalene, superficial cervical plexus and thoracic intertransverse process blocks for surgical anaesthesia of the shoulder disarticulation. Anaesth Rep. 2024;12(1):e12306. Published 2024 May 29. doi:10.1002/anr3.12306
6. Mbabazi P, Mwaniki M, Wambua G, Kagua S, Kamau RW, Daggett J, Nthumba PM. Successful Shoulder Disarticulation under Local Anesthesia in the COVID-19 Era. Plast Reconstr Surg Glob Open. 2023 Sep 13;11(9):e5266. doi: 10.1097/GOX.0000000000005266. PMID: 37711723; PMCID: PMC10499080.
7. Duggappa DR, Rao GV, Kannan S. Anaesthesia for patient with chronic obstructive pulmonary disease. Indian J Anaesth. 2015 Sep;59(9):574-83. doi: 10.4103/0019-5049.165859. PMID: 26556916; PMCID: PMC4613404.
8. Miniato MA, Anand P, Varacallo MA. Anatomy, Shoulder and Upper Limb, Shoulder. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536933/
9. Hamadnalla, H., Elsharkawy, H., Shimada, T. et al. Cervical erector spinae plane block catheter for shoulder disarticulation surgery. Can J Anesth/J Can Anesth 66, 1129–1131 (2019). https://doi.org/10.1007/s12630-019-01421-9
10. Mbabazi P, Mwaniki M, Wambua G, Kagua S, Kamau RW, Daggett J, Nthumba PM. Successful Shoulder Disarticulation under Local Anesthesia in the COVID-19 Era. Plast Reconstr Surg Glob Open. 2023 Sep 13;11(9):e5266. doi: 10.1097/GOX.0000000000005266. PMID: 37711723; PMCID: PMC10499080.

How to Cite this Article: Mangal V, Tontanga MM, Singh C, Mistry T | Redefining Limits: Shoulder Disarticulation Under Regional Anaesthesia Alone | International Journal of Regional Anaesthesia | July-December 2024; 5(2): 16-19 | DOI: https://doi.org/10.13107/ijra.2024.v05.i02.98

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Brachial Plexus Block above the level of clavicle in Multi-Comorbid Patients with Difficult Surface Landmarks and Cervical Ankylosing Spondylosis

December 10, 2024/14 Comments/in Volume 5; Issue 2: July-December 2024/by Ijraijraadmin

Vol 5 | Issue 2 | July-December 2024 | Page 10-12| Nitin Gawai, Sandeep Diwan, Ganesh Bhong, Sunil Dixit, Parag Sancheti

DOI: https://doi.org/10.13107/ijra.2024.v05.i02.94

Open Access License: CC BY-NC 4.0

Submitted: February 18-07-2024; Reviewed: 12-09-2024; Accepted: 14-10-2024; Published: 10-12-2024

Authors: Nitin Gawai [1], Sandeep Diwan [1], Ganesh Bhong [2], Sunil Dixit [1], Parag Sancheti [3]

[1] Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra, India.
[2] Anesthesiology Consultant, Pune, Maharashtra, India.
[3] Department of Orthopaedics, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence

Dr. Nitin Gawai,
Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra, India.
E-mail: drnitingawai@yahoo.com

Abstract

Blocks above the clavicle [BAC- interscalene and supraclavicular] are routinely performed with surface anatomical landmark, and recently with ultrasound. Landmark techniques involving mid-point of clavicle is routinely used. However, with abnormal topography of the clavicle anatomy, the landmarks are distorted. Both, neurostimulation and ultrasound face stiff challenges in patients with abnormal clavicle anatomy. In four patients, with abnormal clavicle, BAC was attempted for surgical corrections of proximal and shaft of humerus. Though landmark and ultrasound guided blocks were successful, we reveal the importance of alternative landmarks and possible complications that might may be associated with abnormal anatomical landmarks.
Keywords: Brachial Plexus Block, Multi-Comorbid Patients, Difficult Surface Landmarks, Cervical Ankylosing Spondylosis

References

1. Katherine M. Shaffer Spread of local anesthetic during an ultrasound-guided interscalene block: does the injection site influence diffusion? Acta Anaesthesiol Scand 2011; 55: 664–669.
2. Franco CD: The subclavian perivascular block. Tech Reg Anesth Pain Manage 1999;3: 212–216.
3. Haleem, Shahla; Siddiqui, Ahsan K.; Mowafi, Hany A. Nerve Stimulator Evoked Motor Response Predicting a Successful Supraclavicular Brachial Plexus Block; More Anesthesia & Analgesia. 110(6):1745-1746, June 2010.
4. Dupre, L.-J., Danel. V., Legrand, J.-J., and Stieglitz, P.: Surface landmarks for supraclavicular block of the brachial plexus. Anesth Analg 1982; 61:28-31.
5. Anand M. Sardesai, Roger Patel, Nicholas M. Denny, David K. Menon, Adrian K. Dixon, Martin J. Herrick, Alan W. Harrop-Griffiths; Interscalene Brachial Plexus Block: Can the Risk of Entering the Spinal Canal Be Reduced? A Study of Needle Angles in Volunteers Undergoing Magnetic Resonance Imaging. Anesthesiology 2006; 105:9–13.
6. Albrecht, J. Mermoud, N. Fournier, C. Kern and K. R. Kirkham A systematic review of ultrasound-guided methods for brachial plexus blockade Anaesthesia 2016, 71, 213–227.
7. Gautier P, Vandepitte C, Ramquet C, DeCoopman M, Xu D, Hadzic A. The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. Anesth Analg. 2011 Oct;113(4):951-5.
8. Gregg A. Korbon, Harold Carron and Christopher J. Lander, First Rib Palpation: A Safer, Easier Technique for Supraclavicular Brachial Plexus Block ANESTH ANALG 1989;68:682-5.
9. Duggan E, El Beheiry H, Perlas A, Lupu M, Nuica A, Chan VW, Brull R. Minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2009 May-Jun;34(3):215-8.
10. Pavičić Šarić J, Vidjak V, Tomulić K, Zenko J. Effects of age on minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block. Acta Anaesthesiol Scand. 2013 Jul;57(6):761-6.
11. Verelst P, van Zundert A. Respiratory impact of analgesic strategies for shoulder surgery. Reg Anesth Pain Med. 2013 Jan-Feb;38(1):50-3. doi: 10.1097/AAP.0b013e318272195d. PMID: 23132510. 12.
12. Plante T, Rontes O, Bloc S, Delbos A. Spread of local anesthetic during an ultrasound-guided interscalene block: does the injection site influence diffusion? Acta Anaesthesiol Scand. 2011 Jul;55(6):664-9.

How to Cite this Article: Gawai N, Diwan S, Bhong G, Dixit S, Sancheti P | Brachial Plexus Block above the level of clavicle in Multi-Comorbid Patients with Difficult Surface Landmarks and Cervical Ankylosing Spondylosis | International Journal of Regional Anaesthesia | July-December 2024; 5(2): 10-12 | DOI: https://doi.org/10.13107/ijra.2024.v05.i02.94

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Redefining Limits: Shoulder Disarticulation Under Regional Anaesthesia Alone

Brachial Plexus Block above the level of clavicle in Multi-Comorbid Patients with Difficult Surface Landmarks and Cervical Ankylosing Spondylosis

Redefining Limits: Shoulder Disarticulation Under Regional Anaesthesia Alone

Brachial Plexus Block above the level of clavicle in Multi-Comorbid Patients with Difficult Surface Landmarks and Cervical Ankylosing Spondylosis

Full Sized Blog Element (Big Preview Pic)

Redefining Limits: Shoulder Disarticulation Under Regional Anaesthesia Alone

Authors: Vandana Mangal [1], Momoson Maring Tontanga [1], Chitra Singh [1], Tuhin Mistry [2]

(Abstract Text HTML) (Download PDF)

Brachial Plexus Block above the level of clavicle in Multi-Comorbid Patients with Difficult Surface Landmarks and Cervical Ankylosing Spondylosis

Authors: Nitin Gawai [1], Sandeep Diwan [1], Ganesh Bhong [2], Sunil Dixit [1], Parag Sancheti [3]

(Abstract Text HTML) (Download PDF)

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