Case Reports | Challenge Journal of Perioperative Medicine

Unexpected venous anomaly around the brachial plexus during supraclavicular block: A case report

Kübra Yazici


DOI: https://doi.org/10.20528/cjpm.2025.01.005
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Abstract


Anatomical variations in the supraclavicular region can greatly affect the success and safety of regional anesthesia techniques, particularly supraclavicular brachial plexus blocks. Identifying these variations is essential to minimize risks. This case involves a 32-year-old male patient with a distal humeral fracture, where an ultrasound-guided supraclavicular block revealed an unusual venous structure encircling the brachial plexus. This atypical vein could pose significant risks, including vascular injury, local anesthetic toxicity, and even cardiac arrest, depending on the anesthetic uBased on its anatomical location and Doppler features, the vein was hypothesized to originate from the subclavian or external jugular vein. This finding underscores the critical importance of thorough ultrasound evaluation and real-time guidance during the procedure to avoid complications. Recognizing such anatomical anomalies is vital to ensuring patient safety, and the integration of ultrasound into routine regional anesthesia practice enhances both precision and effectiveness.


Keywords


brachial plexus; peripheral block; anatomical variation; ultrasound

References


Sites BD, Spence BC, Gallagher J, Beach ML, Antonakakis JG, Sites VR, Hartman GS. Regional anesthesia meets ultrasound: a specialty in transition. Acta Anaesthesiol Scand. 2008;52(4):456-66.

Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: Part 1. Br J Anaesth. 2010;104(5):538-46.

Griffin J, Nicholls B. Ultrasound in regional anaesthesia. Anaesthesia. 2010;65 Suppl 1:1-12.

Kulenkampff D. Die Anästhesierung des Plexus brachialis. DMW-Deutsche Medizinische Wochenschrift. 1912;38(40):1878-80.

Kumari A, Gupta R, Bhardwaj A, Madan D. Delayed pneumothorax after supraclavicular block. J Anaesthesiol Clin Pharmacol. 2011;27(1):121-2.

Singh SK, Katyal S, Kumar A, Kumar P. Massive hemothorax: A rare complication after supraclavicular brachial plexus block. Anesth Essays Res. 2014;8(3):410-2.

Kinjo S, Frankel A. Failure of supraclavicular block under ultrasound guidance: clinical relevance of anatomical variation of cervical vessels. J Anesth. 2012;26(1):100-2.

Lavallée C, Ayoub C, Mansour A, Lambert J, Lebon JS, Lalu MM, Denault A. Subclavian and axillary vessel anatomy: a prospective observational ultrasound study. Can J Anaesth. 2018;65(4):350-9.

Sadowski M, Tułaza B, Lysenko L. Renaissance of supraclavicular brachial plexus block. Anaesthesiol Intensive Ther. 2014;46(1):37-41.

Eskin MB, Ceylan A. Brain edema after ultrasound-guided supraclavicular block. Ann Ital Chir. 2020;9.

Delaunay L, Plantet F, Jochum D. [Ultrasound and regional anaesthesia]. Ann Fr Anesth Reanim. 2009;28(2):140-60.

Go JY, Han DJ, Kim J, Yoon SP. A supraclavicular cephalic vein drained into the subclavian vein. Surg Radiol Anat. 2017;39(12):1413-5.

Paraskevas GK, Raikos A, Chouliaras K, Papaziogas B. Variable anatomical relationship of phrenic nerve and subclavian vein: clinical implication for subclavian vein catheterization. Br J Anaesth. 2011;106(3):348-51.

Turbendian HK, Mesher A, Mitchell MB. Supraclavicular Translocation of Aberrant Left Subclavian Artery for Vascular Ring Division and Resection of Kommerell's Diverticulum. World J Pediatr Congenit Heart Surg. 2020;11(1):108-9.

Mian A, Chaudhry I, Huang R, Rizk E, Tubbs RS, Loukas M. Brachial plexus anesthesia: A review of the relevant anatomy, complications, and anatomical variations. Clin Anat. 2014;27(2):210-21.

Zhang G, Hou X, Wang H, Han C, Fan D. Infraclavicular versus supraclavicular nerve block for upper limb surgeries: A meta-analysis. Medicine (Baltimore). 2024;103(43):e40152.


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