METHOD OF PROLONGED RADIAL NERVE BLOCK FROM AXILLARY APPROACH Russian patent published in 2024 - IPC A61B17/06 A61M19/00 A61M25/02 A61M25/06 

FIELD: medicine.

SUBSTANCE: invention relates to anaesthesiology and intensive care. Ultrasound imaging of anatomical structures is performed in the axillary fossa on the side of the locked extremity, searching for axillary artery, axillary vein, radial nerve, biceps and triceps muscles of shoulder, coracohumeral muscle of shoulder and humerus. Local anesthesia of skin and subcutaneous fat is performed with lidocaine 5 mg/ml in amount of 5.0 ml at the point of access to the radial nerve. Skin and subcutaneous fat are incised 3 mm, in which a guide needle for spinal needles with an outer diameter of 0.9 mm is inserted in the area of an axillary fossa along an anterior axillary line. Wound is widened with a mosquito-type surgical forceps. Under ultrasound control Tuohy guide needle with outer diameter of 1.3 mm and size of 80 mm from this wound is delivered through biceps and coracohumeral muscles. Distal end of the needle is brought to a point between the radial nerve and the fascia of the triceps muscle. Sodium chloride solution 9 mg/ml—10.0 ml is introduced into the space between the radial nerve and the fascia of the triceps muscle, thus, the perineural space of the radial nerve is hydraulically dissected. Through the lumen of the Tuohy guide needle into the space located between the radial nerve and the fascia of the triceps muscle, catheter for prolonged radial nerve block with an outer diameter of 0.85 mm and an inner diameter of 0.45 mm at distance of 15 mm from the distal end of the Tuohy guide needle. Tuohy guide needle is removed. This needle is delivered through the lateral edge of the skin wound, having previously displaced the catheter for the prolonged radial nerve block to the medial edge of the skin wound, under the skin of the subclavian region towards the sternoclavicular joint at distance of 70 mm to the exit of the distal end of the guide needle on the skin surface, thereby forming a subcutaneous canal. Spinal needle with a pencil sharpening of the distal end with an outer diameter of 0.5 mm and length of 103 mm is delivered through the lumen of the Tuohy guide needle from its distal end to the proximal end. Tuohy guide needle is removed from the subclavian skin. Proximal end of the catheter for prolonged radial nerve block is connected to a distal end of a spinal needle located in the subclavian canal, by passing the distal end of the spinal needle into the lumen of the proximal end of the catheter for prolonged radial nerve block at distance of 3 mm, holding the distal end of the spinal needle with a "mosquito" clamp. Spinal needle with a catheter for prolonged radial nerve block is removed from under the skin of the subclavian region, by placing the catheter for the prolonged radial nerve block in the subcutaneous canal. Proximal end of catheter is connected by means of connector with antibacterial filter, which by means of an antibacterial filter retainer is attached to the subclavian skin on the side opposite the locked extremity. Catheter loop measuring 15 mm in diameter is formed at the catheter exit point on the skin of the subclavian region, which is attached to the skin with a fixing device "Perifix". Catheter for prolonged radial nerve block and an antibacterial filter fixed on the skin, connected to a catheter for prolonged radial nerve block, are covered with an aseptic plaster. Under ultrasound control solution of local anesthetic is introduced through lumen of catheter into perineural space located between radial nerve and fascia of triceps muscle.

EFFECT: method enables to perform prolonged analgesia in the treatment of acute and chronic pain syndromes in the area of innervation of the radial nerve from the axillary approach, provide anesthetic management of upper extremity surgeries, perform reliable catheter fixation for prolonged radial nerve block.

1 cl, 14 dwg, 1 ex