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so the procedure starts with the

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positioning of the patient as you can

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see we use very special positioning and

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includes asthma an ability to see the

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motor responsible stimulation as we do

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this okay

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antiseptic is being applied and

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routinely we use a combination midazolam

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and a small amount of ketamine as per

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sedation as you can see we apply the

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generous amounts of antiseptic for every

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procedure we will use customized no

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black set and always standardized more

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aesthetic mixtures for this particular

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purpose we use in a combination of raw

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pure cane and lidocaine so we mixed one

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percent and the pure cane with 2%

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lidocaine for 20 milliliters known

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herbal procedural receive more than

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twenty milliliters of local anesthetic

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so what we see in here is now this is a

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medium fire up here and subcutaneous

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tissue and there's a skin and what we

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want to do with the scanning technique

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is see the brachial plexus sheets so we

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can see the medial side of the sheets

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right hand we can see the conjoined

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tendon in here we can see the axillary

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artery and you can see also the anterior

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sheath over here

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that's the biceps muscle and that is the

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clerk of brachialis muscle and in

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between the two far share of the biceps

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and coracobrachialis

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there is Muscatine mode which obviously

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in this situation we will need to walk

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separately so

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and that is a radial nerve not like them

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here so now when we hear this image we

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need to do some decision-making down

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here is the is the humerus we need to

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check 20 milliliters into that sheath 10

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milliliter and a team leader that is and

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tear to the artery Edmund leader

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posterior to the artery and for me the

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leader for the Moscow Batangas nerve so

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let's get started I think we're gonna go

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first injection close to you to the

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artery over 8 millimeter and will then

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make decisions based on what we get bad

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so that's the needle entering the past

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year subcutaneous tissue infancia now we

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in the biceps the needle is aimed right

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now as you can sometimes also found hmm

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aimed at the axillary artery and we want

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to position the needle behind the

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axillary artery so here then oftentimes

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is a profundity we need to make sure we

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know going through that vessel as you

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enter the street there was a usually

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distinct pop which which happened just

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now okay next thing we want to do is

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check we don't have a nerve stimulation

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at point 5 milliamps that means we not

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on the nerve or in the nerve we always

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look at a tip of the of the tubing at

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the hub of the needle we don't see any

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blood we aspirate the blood is absent

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and now we measure injection pressure

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wanting to make sure that the open

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injection pressure is always low it has

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to be less than 15 psi as we inject we

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would like to see the distribution of

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the work on aesthetic around the

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axillary artery so here we go that's

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pretty good distribution but now since

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we created a little bit of that work on

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aesthetic there a lot of it seems to be

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escaping from the brachial plexus the

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sheathing inner so we need to lift the

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needle tip up and advance the needle of

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the Dubey you're likely are going to get

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another pump

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as you pop through the one of the tissue

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layers or a flashier than inside it's

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good okay

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aspiration again pull back a tiny bit

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aspiration negative okay which continues

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to be absent injection pressure is

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normal now they continue no injection

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work on a static that looks a lot better

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okay so we're going to now complete the

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injection with eight milliliters don't

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walk on the static so here we go we have

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five milliliters they got six

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milliliters

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we got seven milliliters everything

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milliliter we aspirate aspiration

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negative very gentle aspiration we

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continue one even me too not at all

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eight milliliters that comprises the

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injection for students in the arteries

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now we're going to withdraw the needle

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bank and we going to the anterior aspect

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of the artery and lift the needle tip up

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to pass between the adventitia

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of the artery in the median nerve our

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place data okay aspiration is negative

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we look at the hub of the needle which

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is absent an injection pressure is

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normal and we're looking at the

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distribution of the more anesthetic but

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we're not really happy with what we see

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okay we need to clearly see the

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distribution come back a little bit and

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aim up a lot of it above the artery if

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that proves difficult you also can go

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out of the sheath one more time and just

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go above the median nerve all together

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into the sheath yes so as you can see

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there's always elements of

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decision-making as you as you perform

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any nerve workers to do so we're going

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to go above the median nerve we're going

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to enter to the fashion

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push and now lift the needle up to avoid

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the median nerve and then to dip break

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it place a sheet you will feel the pop

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as you do fortunately more in between

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the two nerves yes good aspiration

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negative what is absent not which it is

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the injection now we can see how the

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walk on the static pushes down the other

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nerve and pushes down the median nerve

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she did not advance needle or change the

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needle position but she simply lowered

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the needle tip without advancing or

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withdrawing into the plexus to favor the

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walk on static spread inside the plexus

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okay now in this particular situation I

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do feel that we do need one injection

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here okay so she's going to do advance

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between the artery and the ulnar nerve

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just to make sure that we got even

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spread in the plexus one more time which

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that's it okay aspiration mega thing we

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don't have a blood in the syringe or the

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children to adjust and we're going to

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inject the last two milliliters of work

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on the static and now we can see how

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this particular injection fills the

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sheet around the radial nerve as well as

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complements the block of the other in

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the median nerve so we have ejected

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Edmund leader but Steve's the artery

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combined 8 min later and to you to the

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artery and now we're gonna go back to

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look for the muscular taneous nerve

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which is now marketed here for one more

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last injection of the local anesthetic

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so all we have remain is now is 4

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milliliters okay so we are now back into

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the biceps muscle we don't aim for the

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nerve but we came for the first year

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between the biceps and coracobrachialis

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we've used in the fasciae and pulled the

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middle back into the fashion layer which

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is absent

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we're in a good position right there

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there's no blood

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aspiration is negative and is the

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injection that now peels off

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they must retain its nerve and that's a

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that is a perfect injection for

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muskiness no so that comprises the

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actual brachial plexus one more time

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recognize the sheath conjoined tendon

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okay thanks Larry artery injection of

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eight milliliters of co2 the artery it

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related to the interior into the artery

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and not all three from robot images are

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ideal for this only one doesn't but if

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you stick to the standardized techniques

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you don't have to chase these individual

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words and explore them to the risk of

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nerve injury rather a standardized

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injections of a demo for see your 10ml

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about the artery and falling off or most

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routine is comprises 20 million of total

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products for a brachial plexus clock for

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this procedure the procedure is a

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revision of the amputation of the middle

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finger which will require about an hour

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of time over pretty long time

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Mastering Nerve Blocks: A Detailed Guide to Brachial Plexus Block

In the medical field, mastering nerve blocks is essential, especially when performing procedures like the brachial plexus block. This article provides a step-by-step insight into the techniques and decisions involved in administering a successful brachial plexus block, ensuring optimal patient outcomes. From patient positioning to the distribution of local anesthetic, each detail is carefully explained to guide professionals in this critical medical procedure.

Understanding Patient Positioning and Anesthetic Application

The first crucial step in a brachial plexus block is positioning the patient correctly. Specialized positioning ensures optimal access to the nerve bundle targeted for the procedure. The use of antiseptic and sedation, a combination of midazolam and ketamine, guarantees patient comfort and safety throughout the process. Generous amounts of antiseptic are applied to maintain a sterile environment for the customized nerve block procedure.

Identifying Key Nerve Structures

During the procedure, identifying key nerve structures within the brachial plexus is paramount. By using a scanning technique, medical professionals can visualize the brachial plexus sheaths, axillary artery, and surrounding muscles. Understanding the anatomical landmarks, such as the biceps muscle and the radial nerve, aids in precise needle placement for the nerve block.

Executing the Injection Process

Administering the local anesthetic involves a meticulous approach to ensure optimal distribution without damaging surrounding structures. By monitoring nerve stimulation and injection pressure, healthcare providers can safely deliver the anesthetic around the targeted nerves. Careful observation of the anesthetic spread and making necessary adjustments during the injection process are critical for a successful brachial plexus block.

Enhancing Technique through Decision-making

Throughout the procedure, constant decision-making is required to overcome challenges and optimize the effectiveness of the nerve block. Adjusting the needle position, monitoring anesthetic distribution, and ensuring minimal nerve stimulation are all part of the intricate process involved in mastering nerve blocks like the brachial plexus block.

Conclusion: Advancing Skills in Nerve Blocks

Mastering nerve blocks, especially complex procedures like the brachial plexus block, demands precision, skill, and attention to detail. By following standardized techniques and making informed decisions during the injection process, healthcare professionals can achieve successful outcomes while minimizing the risk of complications. Continuous practice and refinement of skills are key to becoming proficient in performing nerve blocks effectively.

In conclusion, mastering nerve blocks is a continuous learning process that requires commitment and expertise. Each procedure offers opportunities to improve techniques and optimize patient care, ultimately enhancing the quality of medical interventions and patient outcomes.

From mastering the art of nerve blocks to achieving precision in procedural techniques, healthcare professionals play a vital role in delivering safe and effective medical care.