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Brachial plexus disorder — Clinical Guidelines

Overview

Brachial plexus disorders encompass a range of injuries affecting nerves in the shoulder and arm, often requiring precise diagnostic and procedural skills for effective management, particularly in ultrasound-guided blocks.

Diagnosis

Key Diagnostic Criteria: Identification of nerve involvement through clinical examination and imaging.

Recommended Tests: Ultrasound and MRI for anatomical assessment 4.

Grading: Utilization of metrics-based assessment tools to differentiate between expert and novice performance in ultrasound-guided procedures 3.

Management

First-Line Treatments: Ultrasound-guided axillary brachial plexus blocks for pain management and anesthesia 1 3.

Adjunctive Treatments: No specific adjunctive treatments mentioned in abstracts; focus on procedural skill mastery and competency assessment 1 3.

Special Populations

Pregnancy: No specific data provided in abstracts.

Pediatrics: No specific data provided in abstracts.

Elderly: No specific data provided in abstracts.

Comorbidities: No specific considerations noted for comorbidities in the provided abstracts.

Key Recommendations

Utilize risk-adjusted learning-curve methods (RA-LC-CUSUM) to accurately assess competency in performing brachial plexus blocks, enhancing procedural safety and efficacy (Evidence: Moderate 1).

Implement structured training programs with both massed and distributed practice to optimize learning curves for ultrasound-guided procedures, though no significant difference was observed between practice methods in proficiency scores (Evidence: Moderate 2).

Employ validated metrics-based assessment tools to reliably differentiate between expert and novice performance in ultrasound-guided axillary brachial plexus blocks (Evidence: Strong 3).

References

1 de Oliveira Filho GR, Soares Garcia JH. The Accuracy of the Learning-Curve Cumulative Sum Method in Assessing Brachial Plexus Block Competency. Anesthesia and analgesia 2024. link 2 Barrington MJ, Viero LP, Kluger R, Clarke AL, Ivanusic JJ, Wong DM. Determining the Learning Curve for Acquiring Core Sonographic Skills for Ultrasound-Guided Axillary Brachial Plexus Block. Regional anesthesia and pain medicine 2016. link 3 Ahmed OM, O'Donnell BD, Gallagher AG, Breslin DS, Nix CM, Shorten GD. Construct validity of a novel assessment tool for ultrasound-guided axillary brachial plexus block. Anaesthesia 2016. link 4 Helayel PE, Conceição DB, Nascimento BS, Kohler A, Boos GL, Oliveira Filho GR. Learning curve for the ultrasound anatomy of the brachial plexus in the axillary region. Revista brasileira de anestesiologia 2009. link 5 Nakamichi K, Tachibana S. Intraneural ganglion of the branchial plexus. Journal of hand surgery (Edinburgh, Scotland) 1998. link80243-x)

Brachial plexus disorder