Cleveland Clinic cadaver course brachial plexus

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In November 2019 Dr Pawa was invited to lecture and teach at the World Famous Cleveland Clinic for the 6th Annual Cadaveric Regional Anaesthesia Course & POCUS Workshop. This Lecture was on Anatomy and Ultrasound of the upper limb and featured mostly videos - PDFs of the slides are available here and credit must go to 3D4Medical app Essential Anatomy 5 that Dr Pawa used to create the video animations

Atención sanitaria

Anatomy & Ultrasound of
the Brachial Plexus
Dr Amit Pawa @amit_pawa

Disclosures
RA-UK President
Honoraria from GE Healthcare
Consult for B Braun Medical Ltd
@amit_pawa

$Outline of next 25mins Brachial Plexus Interscalene Superior Trunk Supraclavicular Infraclavicular (& Retroclavicular) Axillary Suprascapular Nerve Block Axillary Nerve Block Distal Nerves (Elbow/Mid- forearm @amit_pawa$

$Brachial Plexus C5 C6 C7 C8 T1 Roots Trunks Divisions Cords Branches @amit_pawa Superior Middle Lower Lateral Posterior Medial Median Ulnar Musculocut Axillary Radial SSN Lat Pectoral Med Pectoral MBN MABN DSN LTN Interscalene Supraclavicular STB infraclavicular Axillary Axillary SSN$

Interscalene
SCM
Anterior Scalene
Middle Scalene
C5
C6
@amit_pawa
C7
DSN
LTN

No Anterior
tubercle of
C7 TP
@amit_pawa

Superior Trunk
1st Rib
Omohyoid
Anterior Scalene
Middle ScaleneSuperior Trunk
Subclavian Art
@amit_pawa

ASM MSM
SCA
Plexus
1st Rib
Pleura
Omohyoid
Trapezius
Supraclavicular
@amit_pawa

$Infraclavicular$

$Infraclavicular @amit_pawa$

$Infraclavicular Pec Major Pec Minor AxA AxV Lat Pos M ed @amit_pawa$

$Infraclavicular Arm in Abduction @amit_pawa$

Issues with Classical IFCB
Steep insertion angle
Poor needle visibility
Vessels in needle path
Narrow space between clavicle & probe
@amit_pawa

$Retroclavicular APproach To Infraclavicular Region @amit_pawa$

Axillary Brachial Plexus
Humerus
Biceps Brachii
Coracobrachialis
Teres Major &
Latissimus Dorsi
AxA
AxVM
U
R
MCN
@amit_pawa

Avoiding ISB may AVOID…
Phrenic Nerve Palsy (PNP)
Injury to Roots & DSN/LTN
Pneumothorax
Inadvertent arterial injection & L.A.S.T…..
@amit_pawa

Instead of ISB
Superior Trunk Block
Suprascapular nerve (SSN) block
SSN plus Axillary Nerve Block
@amit_pawa

Suprascapular Nerve
Trapezius
Supraspinatus
SSNSSA @amit_pawa

Axillary NERVE
PCHA AxN
Deltoid
Humerus @amit_pawa

Ulnar Nerve
FCU
FDS
FDP
UN UA
@amit_pawa

Radial Nerve
Brachioradialis
Brachialis
RN
LABCN
Ceph vein
@amit_pawa

Thank You
amit.pawa@gstt.nhs.uk @amit_pawa

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2. Disclosures RA-UK President Honoraria from GE Healthcare Consult for B Braun Medical Ltd @amit_pawa

3. Back To Med School @amit_pawa

4. Outline of next 25mins Brachial Plexus Interscalene Superior Trunk Supraclavicular Infraclavicular (& Retroclavicular) Axillary Suprascapular Nerve Block Axillary Nerve Block Distal Nerves (Elbow/Mid- forearm @amit_pawa

5. Let’s Go!

6. Brachial Plexus C5 C6 C7 C8 T1 Roots Trunks Divisions Cords Branches @amit_pawa Superior Middle Lower Lateral Posterior Medial Median Ulnar Musculocut Axillary Radial SSN Lat Pectoral Med Pectoral MBN MABN DSN LTN

7. Brachial Plexus C5 C6 C7 C8 T1 Roots Trunks Divisions Cords Branches @amit_pawa Superior Middle Lower Lateral Posterior Medial Median Ulnar Musculocut Axillary Radial SSN Lat Pectoral Med Pectoral MBN MABN DSN LTN Interscalene Supraclavicular STB infraclavicular Axillary Axillary SSN

8. Interscalene

9. Interscalene @amit_pawa

10. Interscalene SCM Anterior Scalene Middle Scalene C5 C6 @amit_pawa C7 DSN LTN

11. No Anterior tubercle of C7 TP @amit_pawa

12. @amit_pawa

13. Interscalene @amit_pawa

14. Superior Trunk

15.

16. Superior Trunk @amit_pawa

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18. Superior Trunk @amit_pawa

19. Supraclavicular

20. Supraclavicular @amit_pawa

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22. Supraclavicular @amit_pawa

23. Infraclavicular

24. Infraclavicular @amit_pawa

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27. Issues with Classical IFCB Steep insertion angle Poor needle visibility Vessels in needle path Narrow space between clavicle & probe @amit_pawa

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29. Retroclavicular APproach To Infraclavicular Region @amit_pawa

30. @amit_pawa

31. Axillary Brachial Plexus

32. Axillary Brachial Plexus @amit_pawa

33. Axillary Brachial Plexus @amit_pawa

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35. Axillary Brachial Plexus @amit_pawa

36. Outline of next 25mins Brachial Plexus Interscalene Superior Trunk Supraclavicular Infraclavicular (& Retroclavicular) Axillary Suprascapular Nerve Block Axillary Nerve Block Distal Nerves (Elbow/Mid- forearm @amit_pawa

37. Outline of next 25mins Brachial Plexus Interscalene Superior Trunk Supraclavicular Infraclavicular (& Retroclavicular) Axillary Suprascapular Nerve Block Axillary Nerve Block Distal Nerves (Elbow/Mid- forearm @amit_pawa

38. @amit_pawa

39. Avoiding ISB may AVOID… Phrenic Nerve Palsy (PNP) Injury to Roots & DSN/LTN Pneumothorax Inadvertent arterial injection & L.A.S.T….. @amit_pawa

40. Instead of ISB Superior Trunk Block Suprascapular nerve (SSN) block SSN plus Axillary Nerve Block @amit_pawa

41. Suprascapular Nerve

42. Suprascapular Nerve @amit_pawa

43. Suprascapular Nerve Trapezius Supraspinatus SSNSSA @amit_pawa

44. Axillary NERVE

45. Axillary NERVE @amit_pawa

46. Axillary NERVE PCHA AxN Deltoid Humerus @amit_pawa

47. Nerves of the Forearm

48. Median Nerve

49. Median Nerve @amit_pawa