Supraclavicular Regional Anaesthesia Revisited

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dc.contributor.advisor Weller, Jenny en Cornish, Philip Bruce en 2015-12-21T02:29:57Z en 2015-12-21T02:29:57Z en 2015-12-21 en
dc.identifier.uri en
dc.description.abstract Supraclavicular block of the brachial plexus was long regarded as the quintessential skill of the regional anaesthetist: it was quick to perform, and effective at providing sensory and motor block of the arm, but significant skill was required to manage the risk of pneumothorax. Indeed, for this reason, it was often avoided by many practitioners for fear of both clinical and medicolegal consequences. More recently, there has been a resurgence of interest in supraclavicular block: the introduction of ultrasound, with its ability to visualize structures, in particular, improves the safety profile of the technique. This thesis undertakes a comprehensive reappraisal of the applied anatomy of the supraclavicular area, and evaluates how this knowledge might affect the complication/side effect profile of supraclavicular block. Initially, the aim was restricted to trying to lessen the risk of pneumothorax by using the mathematical principle of the tangent, with the anatomy of the area requiring a bend in the block needle, but the project evolved into the more comprehensive task of also trying to alter the risk of blocking the phrenic nerve, sympathetic chain, and recurrent laryngeal nerve. As secondary goals, the thesis aims to better place the technique in terms of its clinical utility, and examines how detailed knowledge of the anatomy can usefully be dovetailed with the emergent ultrasound technology. A number of anatomic and clinical studies were performed. These included examining the relationships between the clavicle, brachial plexus and chest wall, studying the block’s clinical profile, investigating the incidence of phrenic nerve block and studying the mechanism for its avoidance, and reevaluating the anatomic structures which surround the brachial plexus and influence flow and spread of injected solution. The results have added to the knowledge base of applied anatomy: in particular, they afford new insights into the role of the first rib, clavicle, and scapula. They have also challenged one of the traditional cornerstones of brachial plexus regional anaesthesia, the ‘sheath’. The study technique evolved to incorporate the modern technology, becoming ultrasound-guided axillary tunnel block. The clinical versatility of this technique and its ability to avoid the phrenic nerve are clear advantages. Together, these observations enhance our understanding of the anatomic dynamics involved in brachial plexus blockade, and the thesis presents a new model based on the rigid anatomy surrounding the plexus. en
dc.publisher ResearchSpace@Auckland en
dc.relation.ispartof PhD Thesis - University of Auckland en
dc.relation.isreferencedby UoA99264832309002091 en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. en
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dc.title Supraclavicular Regional Anaesthesia Revisited en
dc.type Thesis en The University of Auckland en Doctoral en MD en 2015-12-21T02:29:17Z en
dc.rights.holder Copyright: The author en
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