PMC7586149_01
Humerus fracture with lytic lesion.
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fig1
X-ray revealed fracture shaft of humerus with multiple lytic lesions (Figure 1).
Preliminary scan showing brachial plexus in the interscalene groove. Arrow indicates needle direction. Abbreviations: ASM, anterior scalene muscle; LA, local anesthesia; MSM, middle scalene muscle; MT, middle trunk; ST, superior trunk; SCM, sternocleidomastoid muscle.
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fig2
Preliminary scan was done to visualize brachial plexus in the interscalene groove (Figure 2) with ultrasound (Samsung My SONO U6) with linear probe.
Local anesthesia spread around the brachial plexus trunk with needle. Arrow indicates needle direction. Abbreviation: ASM, anterior scalene muscle; LA, local anesthesia; MSM, middle scalene muscle; MT, middle trunk; ST, superior trunk; SCM, sternocleidomastoid muscle.
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fig3
Using the in-plane technique and taking care of asepsis, ultrasound compatible needle (PAJUNK, SONOPLEX STIM, 20G x 150 mm) was used to infiltrate the three trunks, mostly superior and middle trunk and lower trunk the least (Figure 3), with total 20 ml local anesthetic (Two 10 ml syringe each containing 5 ml of 1% lignocaine with adrenaline (1 : 100000) and 5 ml of 0.25% bupivacaine plain after dilution). At the time of injection and spread of local anesthetics, caution was taken to visualize the tip of the needle below the superior trunk in the interscalene groove and away from the plane of anterior scalene and sternocleidomastoid to avoid phrenic nerve blockade (Figure 3).