title: The presence of transverse cervical and dorsal scapular arteries at three ultrasound probe positions commonly used in supraclavicular brachial plexus blockade.
abstract: BACKGROUND
  Ultrasound-guided supraclavicular brachial plexus block carries a risk for puncture of vascular structures. In this study, we determined the frequency with which the transverse cervical artery (TCA) and the dorsal scapular artery (DSA) are detected by ultrasound evaluation at 3 probe positions during supraclavicular block.
  
  
  METHODS
  Ultrasound examinations of the supraclavicular region were performed in 53 healthy adult volunteers. Ultrasound images of the supraclavicular region were acquired at 3 probe positions: position A (the brachial plexus and the subclavian artery both lying on the first rib); position B (the brachial plexus on the first rib; the artery on the pleura); and position C (the brachial plexus between the anterior and middle scalene muscles). The primary outcome variables were the frequencies with which TCA and DSA were detected by 2-dimensional and color Doppler imaging at 3 specified probe positions.
  
  
  RESULTS
  One hundred six supraclavicular regions were examined in 53 subjects. The subclavian artery was detected in all subjects. TCA was more often detected than DSA, 94 (88.7%, 95% confidence interval [CI] 80.7%-93.8%) and 36 (34%, 95% CI 25.3%-43.9%) of 106 scans, respectively (McNemar P value <0.001). TCA was detected in 2 (1.9%, 95% CI 0.3%-7.3%), 31 (29.2%, 95% CI 20.9%-38.9%), and 61 (57.5%, 95% CI 47.5%-66.9%) of scans at probe positions A, B, and C, respectively, whereas DSA was detected in 3 (2.8%, 95% CI 0.7%-8.6%), 23 (21.7%, 95% CI 14.5%-30.9%), and 10 (9.4%, 95% CI 4.8%-17.0%) of scans at probe positions A, B, and C, respectively. Thus, the TCA and DSA were less likely to be present with probe position A (all P < 0.001).
  
  
  CONCLUSIONS
  TCA was more often detected than DSA in the vicinity of the brachial plexus in the supraclavicular region. Both TCA and DSA were least likely to be present in probe position A. Color Doppler, particularly for probe position A, may help to reduce the risk for inadvertent vascular puncture during ultrasound-guided supraclavicular block.
authors.affiliation: Department of Anesthesiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. h-murata@nagasaki-u.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Murata
authors.forename: Akiko
authors.initials: A
authors.lastname: Sakai
authors.forename: Admir
authors.initials: A
authors.lastname: Hadzic
authors.forename: Koji
authors.initials: K
authors.lastname: Sumikawa
mesh_terms: D001917:Brachial Plexus / Q000000981:diagnostic imaging*; D006801:Humans; D007564:Japan; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D011237:Predictive Value of Tests; D012782:Shoulder / Q000098:blood supply* / Q000294:innervation*; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000293:injuries; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional / Q000379:methods*; D057772:Vascular System Injuries / Q000209:etiology / Q000517:prevention & control