title: Assessment of variation in depth of brachial plexus using ultrasound for supraclavicular brachial plexus block in patients undergoing elective upper limb surgery.
abstract: OBJECTIVE
  Supraclavicular approach to the brachial plexus may be associated with complications such as pneumothorax, inadvertent vascular puncture, inter-scalene block and neurovascular injuries. The present study was conceived to find out the variation in depth of brachial plexus to suggest the minimum length of needle required to effectively perform the block, thus preventing possible complications.
  
  
  METHODS
  After approval from our Institutional Ethical Committee, informed and written consent was obtained from each of the ninety American Society of Anesthesiologists Physical Status I and II patients recruited, of either sex in the age group of 20-50 years. Supraclavicular fossa was scanned using a high-frequency linear probe, and the distances (shortest distance [SD] from skin to the most superficial neural element and longest distance [LD] from skin to the most deep neural element) were measured using on-screen callipers on optimal frozen image. Pearson correlation was used to find out the relation between these two distances and demographic parameters.
  
  
  RESULTS
  Mean SD was 0.60 ± 0.262 cm, and mean LD was found to be 1.34 ± 0.385 cm. We observed significant correlation between these two distances with weight and body mass index (BMI).
  
  
  CONCLUSIONS
  Significant correlation was observed between SD and LD with weight and BMI. We suggest that a needle with a shaft length of 3 cm will be sufficient to reach the sheath of the brachial plexus during performance of the block.
authors.affiliation: Department of Anaesthesiology and Critical Care, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
authors.forename: Tuhin
authors.initials: T
authors.lastname: Mistry
authors.affiliation: Department of Anaesthesiology and Critical Care, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
authors.forename: Vandana
authors.initials: V
authors.lastname: Mangal
authors.affiliation: Department of Anaesthesiology and Critical Care, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Sharma
authors.affiliation: Department of Medical and Health, National Health Mission, Rajasthan, India.
authors.forename: Aachu
authors.initials: A
authors.lastname: Agrawal
keywords: Brachial plexus; depth; supraclavicular block; ultrasound