Plexus Anaesthesia
Contents
1. The use of the Two options to adjust imuplex system i for an inguinal the stimulation current paravascutar Har kli Via Remote Control RC umbar plexus E special socket to connect the new Remote Control RC 3 in 1 block or normal control knob E stimulation can also be done via the control knob Logarithmic current regulation E precise current adjustment especially in the low range around 0 2 mA Stimuplex A needles With special short bevel E extremely smooth gliding through all tissue layers E easily identifies the perivascular space by a distinct click E reduces the risk of nerve damage Stimuplex A needles with fully insulated needle shaft are available in 6 lengths with appropriate diameters Your choice for upper and lower limbs under code no 489 2216 B Technical Data Remote Control Technical Data Stimuplex Dig RC Remote control for sterile one hand operation Simultaneous puncture and stimulation E no coordination problems with assistance staff E more attention to the patient Safe placement in the anaesthetist s palm E easy fixation with two finger rings W sterile handling due to a glove to be put on the usual way Operation by two small Up and Down buttons only E tactile feeling combined with acoustic control The new Remote Control RC is offered separately and available Fixing Via finger rings on the Impulse amplitude 0 5 0 mA constant2. Full compatibility guaranted Stimuplex Feed back for high safety and success rates E concetrates the entire stimulus current at the very needle tip WE supports precise nerve loacalization at lowest threshold Extremely narrow treshold curves pro vides E excellent estimation of the distance between the needle tip and the nerve E most accurate needle posi tioning using lowest thres hold currents 3 3 mA max 5 mMApp OQ 12 kQ max 65 Vpp 1 Hz 2Hz Adjustment control display 3 set point Flowing current display 2 actual value based on set mA values 5 mA or 1 mA Please note Stimuplex HNS 11 nerve stimulator is also compatible with Stimuplex A needles see page 4 5 Contiplex D A Alphaplex Sets for continuous plexus blockades with and without nerve stimulation The Contiplex and Alphaplex sets are offe Contiplex D and A ial cathet d dified 18G IV sets are available ring special catheters and a modifie V a cannula with differently bevelled insulated as a single sterile needles according to your choice connuloe The Contiplex D consists of the well proven Stimuplex needle with all the advantages men tioned before These devices can be connected to a Stimuplex nerve stimulator HNS 11 or Dig RC in order to gain the ideal position of the needle tip avoiding mechanical paraesthesia The Contiplex catheter which is made of the Same polyamide materia
3. 10 100 100 100 B Braun Regional Anaesthesia Equipment Get the complete range Spinocan Needle for spinal anaesthesia Quincke bevel Atraucan Special needle for spinal anaesthesia Paediatric sizes Pencan Special needle with pencil point bevel Paediatric sizes Spinocath Set for continuous spinal anaesthesia and pain treatment CSA Espocan Set for spinal epidural anaesthesia Perifix Perifix Soft Continuous epidural and caudal anaesthesia trays complete sets sets with Loss of Resistance Device L 0 R filter sets mini sets catheter screw connector L O R device Perifix EF Epidural flat filter Perican Needle with Tuohy bevel Perifix LO R Low friction device for the L 0 R technique Perifix Paed Dearne Paediatric epidural sets and needles This low friction device has limited aspiration capabilities for use with fluids Perifix L O R should not be used for injections of drugs Literature Fischer HBJ 1996 Selander D et al 1977 Peripheral Nerve Blockade Priniciples and Practice 11 13 Peripheral nerve injury due to injection needles used for Regional Anaesthesia Churchill Livingstone Acta anaesth scand 21 182 188 Klein R et al 1994 Winnie A P 1990 The efficacy of an improved method for selectively placing a catheter for Perivascular techniques of brachial plexus block continuous axillary brachial plexus anaesthesia Mediglobe SA Regional Anesthe
4. are several methods of identifying the brachial plexus e g eliciting a paraesthesia with the needle point using a nerve stimulator or recognising the click as the needle enters the sheath With practice successrate will improve The Art of Regional Anaesthesia 2 Choice of LA The duration of surgery decides choice of LA Short acting LAs are lido mepiva and prilocaine with durations from 1 5 3 h adrenaline 5 ug ml prolongs duration with some 50 The long acting bupivacaine and ropivacaine may last from 5 10 h or more It is important to inject a sufficient volume of the LA for a reliable block For supra and infracla vicular techniques 20 40 ml are needed for axillary blocks 40 50 ml 3 Continuous technique Using a continuous technique surgical anaesthesia can be prolonged as needed by intermittent bolus or continuous infusion of the LA Regional postoperative analgesia can be extended for several days by similar administration of a low concentrated long acting LA which will minimize motor blockade With this technique effective pain relief can be achieved without the side effects of opioids or other central ly acting analgesics As sympathetic blockade will accompany sensory blockade the limb will remain vasodilated which is highly advantageous after replantation operations For reliable and safe plexus blocks the patient should be adequately monitored and only lightly sedated The ana esthetist should
5. position the needle tip close to the nerve In addition it is well tolerated by the patient because it is not necessary to elicit paraes System for single shot technique with nerve stimulation Stimuplex DIG nerve stimulator Only one knob for operation E current setting and measuring at the same time without using an additional switch E yellow LED indicates every current pulse E flashing display if current flow is less than set current Impulse width 0 1 ms E reliable stimulation of motor fibres without stimulation of afferent fibres pain thesia Stimuplex with its high level of safety by continuous feed back represents the ideal system for training in plexus blockade as well as for daily clinical routine Indications for Stimuplex Dig RC A E ideal for plexus block ades of the upper and lower limbs E especially suitable for plexus blockades of the lower limbs e g 3 in 1 block E nerve plexus blockades for patients who are not able to communicate and cooperate e g sedated patients and patients under general anaesthe sia Selectable impulse frequency E for most convenient and reliable stimulation NEW Integrated electrode cable E more stable and integrated cable for better protection against damage E avoids inadvertent mix ups with other cables e g HNS 11 or its loss NEW Extended acoustic control of the stimulus E optimum security during the entire perfor mance
6. Plexus Anaesthesia Reliability and success with Stimuplex Contiplex and Alphaplex The leading edge in Plexus Anaesthesia Equipment B BRAUN Plexus Anaesthesia Introduction to Brachial Plexus Block by Dag E Selander MD PhD Gothenburg Sweden Blockade of the brachial plexus with local anaesthetics can provide anaesthesia of the upper extremity from the shoul der to the fingertips Correctly performed plexus block offers excellent regional anaesthesia and muscle relaxation for Surgery and a method for long term postoperative analgesia both with minimal interference with the patient s vital func tions The extent and duration of the block can be tailored to meet the needs required by the type of surgery and the patient s condition by selecting 1 the site of injection 2 the local anaesthetic LA and 3 the use of either a single shot or a continuous technique In principal the same applies to plexus anaesthesia of the lower limbs Besides skill and experience adequate injection equipment and local anaesthetics form the basis for an atraumatic and successfull plexus blockade 1 Site of injection The neurovascular sheath which surrounds the brachial plexus and concomitant major blood vessels from the neck to the mid upper arm allows blockade by a single injection into the sheath at three principal levels supraclavicular interscalene and subclavian perivascular infraclavicular or axillary There
7. be familiar with signs and symptoms of overdosage and prepared to treat such situations To avoid neural complications peripheral nerves should be handled with care i e use recommended LAs and short bevel needles and try to avoid rough paraesthesiae Developed and manufactured in strict accordance with the requirements of clinical practice The B Braun Range E Stimuplex Systems for single shot technique with nerve stimulation Stimuplex HNS 11 nerve stimulator and Stimuplex D needles Stimuplex Dig RC and Stimuplex A needles E Contiplex and Alphaplex Sets for continuous blockade with and without nerve stimulation New Contiplex D 110 mm set with newly designed catheter Peripheral Electrical Nerve Stimulation PENS Principles By simplifying the accurate location of peripheral nerves peri pheral electrical nerve stimulation PENS facilitates the perfor mance of nerve and plexus blocks increasing their safety and reliability The old rule no paraesthesia no anaesthesia loses its validity because information from the patient concerning paraesthesia is eliminated and the danger of a mechanical ner ve lesion is largely excluded The principle consists of triggering depolarizations with electrical pulses at but not within the nerve causing muscular contractions at the effector muscle or sensitive sensations in the distribution area Paraesthesia due to direct contact of injection needles and ne
8. current palm infinitely adjustable Sterility To be placed under the Impulse frequency 1 Hz and 2 Hz switchable sterile glove Impulse width 0 1 msec Adjustment Set required current value Digital display 3 digits from 0 2 4 99 mA by pressing the buttons 2 digits from 5 0 mA Up or Down Resolution 0 01 mA Connection Via steering cable to the Output voltage 32 Vpp max tripolar output socket on Battery 9 volt type 6 LR 61 or 6F 22 the front panel of the Electrode cable integrated Stimuplex Dig RC Battery check red LED Case Housing Plastic Dimensions 11 4X 7 2 X 3 3 cm Practice proven lengths of electric cable and injection tube E provide the necessary dis tance to the unsterile area E allows for aspiration and injection using the immobile needle technique Ergonomic needle hub E allows precise needle guidance during puncture Please note Stimuplex Dig RC nerve stimulator is also compatible with Stimuplex D needles see page 6 7 Stimuplex Feed back for high safety and success rates Stimuplex HNS 11 Stimuplex D The new nerve stimulator Stimuplex HNS 11 in combination with Stimuplex D the latest generation of stimulation needles provides high level safety and success rates Selectable stimulus duration offers either to selectively stimulate motor fibres of mixed nerves or to stimulate sensory fibres for loca ting pure sensory nerves Prec
9. ex Sets with catheter 0 9 x 1 25 x 330 mm guide wire and Contiplex D D 28 055 C 15 and 30 bevel Basic Set 15 bevel E S mm S per Set 15 bevel T 55 mm Basic Set 30 bevel 55 mm Super Set 30 bevel 3 x 55 mm Plexufix needle with 45 short bevel and extension tubing 0 75 x 1 85 x 300 mm 24G x1 0 55 x 25mm 24G x 2 0 55 x 50 mm Extension tubing for Plexufix OW Sales 230MM Electrode cable for Stimuplex HNS 11 for Stimuplex A D and Contiplex D needles length 125 cm Electrode cable for Stimuplex Dig RC for Stimuplex A D and Contiplex D needles length 150 cm Remote Control for sterile one hand operation especially for Stimuplex DIG RC Fingerrings especially for Stimuplex DIG RC Knob for sterile handling especially for Stimuplex HNS 11 Adaptor cable for Contiplex A needle and electrode cable type or Length 75 cm autoclavable up to 130 234 F Adaptor cable for needles other than B Braun to fit or suitable for almost all stimulation needles autoclavable up to 130 234 F Code Number 0489 4251 0489 4539 0489 4502 0489 4375 0489 4260 0489 4278 0489 3611 0489 3643 0489 3603 0489 3638 U 180 0210 U 180 0200 U 180 0201 U 180 0203 0489 1520 0489 1562 0489 1511 0489 2070 489 2917 B 489 2216 B 489 2224 B 0489 2089 0489 2925 0489 2941 Sales Unit 25 25 25 25 25 25 25 25 10 10 10 10 10
10. ise measurement of the delivered stimulus current allows a very accurate positioning of the needle tip close to the nerve The new Stimuplex D needle with special coating features a non cutting atraumatic be vel The pin point electrode supports optimal nerve localization Indications for Stimuplex HNS 11 D W localization of practically all mixed nerves for plexus and peripheral nerve blocks by selective stimulation of motor fibres with out causing unpleasant sensations E in addition pure sensory nerves e g lateral femoris cutaneous nerve can be located using a longer pulse duration to stimulate sensory fibres This is usefull for nerve blocks e g in pain treatment Single shot technique with new first class technology Stimuplex HNS 11 nerve stimulator Switchable linear current ranges E high resolution fine adjustment of stimulus amplitudes E especially suitable for technically sophisti cated needles with pin point electrodes E current ranges 0 1 mA and 0 5 mA Selectable pulse duration E selective stimulation of motor fibres 0 1 ms E additional stimulation of afferent fibres 1 0 mA Acoustical and optical stimulus indication E excellent control an feed back of the stimu lator functions Various alarm functions E avoid failure of the procedure in case of e g bad electric circuit low battery etc The use of Stimuplex system for the blockade of the lateral femoris cuta neou
11. l as the well known Perifix catheter provides all the advantages of a continuous technique Special emphasis was laid on the tip forming process to create a smooth and atraumatic tip for the new Alphaplex catheter Contiplex catheter The atraumatic tip design E easy and atraumatic inser tion as with the well tried and proven Perifix epidu ral catheter Approved polyamide material E for prolonged implantation Contiplex D cannulae Attached to both Contiplex D and Alphaplex sets E Stimuplex D needle design E simultaneous stimulation and aspiration injection E available with 15 and 30 bevel to chose preferred puncture characteristics Indications for Contiplex and Alphaplex E long duration anaesthesia for prolonged operations on upper limb E postoperative analgesia for as long as required E prolonged treatment for painful conditions such as reflex sympathetic dystro phy or cancer pain E a differential nerve block when required E optimal blood flow follow ing replantations E excellent anaesthesia for hand operations and fractures of the radius E active physiotherapy with out pain Ideal for plexus blockade of the upper limbs Contiplex and Alphaplex A real contribution to plexus blockade Take your choice Alphaplex sets with Seldinger wire and Contiplex D cannulae are available in 4 different versions see page 11 Seldinger guide wire wi
12. nerve The shorter the electrical pulse pulse width the faster is the rise in current to the nerve and the clearer the discrimination as to whether the needle tip is sufficiently close to the nerve The stimulation needle should always be connected to the ne gative pole because higher currents are required if the polarity is reversed needle positive The geometry of the electrical current field is dependent on the geometry of the conductive tip of the stimulation needle The smaller the emission site of the electrons at the tip of the needle the higher is the current density at this point and the lower the threshold current when the nerve is exactly localized The B Braun stimulators Stimuplex HNS 11 and the new Stimuplex Dig RC have been designed according to the most modern aspects and the requirements which originate from the theory and practice of peripheral electrical nerve stimulation They are provided with alarm systems necessary for the early detection of technical faults which could endanger the patient and place the success of the anaesthesia in jeopardy Stimuplex Dig RC Stimuplex A needles This Stimuplex system is composed of the up dated nerve stimulator Stimuplex Dig RC with the option of nerve stimulation via Remote Control RC and a range of corresponding Stimuplex needles with atraumatic short bevelled tips The Stimuplex system allows a very smooth and target directed procedure to
13. r 0 45 x 0 85 x 400 mm with cannula D 28 055 C 18G x 2 s 15 bevel with cannula D 18 055 C 18G x 21 2 30 bevel with Contiplex catheter 0 45 x 0 85 x 1000 mm with cannula D 28 110 C 18G x 43 3 15 bevel Can 0 D x ula 05 xm35 mim 05x55 mMm 0 6 x 40mm 0 6 x 70 mm 0 7 x 50 mm 0 7 x 80 mm 0 7 x 120 mm 0 9 x 150 mm 0 7 x 40 mm 0 7 x 50mm 0 7 x 80mm 1 3x 55mm 1 3 X 110 mm Lox SS mm 13x 55mm 13x 55mm 1 3 X 110 mm Length Code Number 0489 2097 489 1996 B 0489 4103 0489 4111 0489 4120 0489 4138 0489 4146 0489 4154 0489 4162 0489 4170 0489 4189 0489 4197 0489 4200 0489 4219 0489 4294 0489 4227 0489 4235 0489 4243 0489 4391 Sales Unit 29 25 25 29 25 25 25 29 25 25 25 25 25 25 Product Type Needles cannulae and sets for peripheral nerve stimulation Set for Immobile Needle technique acc to Winnie Accessories for plexus anaesthesia cS Product Description Canula 0 D x Length Stimuplex A needles with 30 bevel A 25 24G x 1 0 55x 25mm Gy ING lt 1 OO 25 mm A 50 22Gx2 0 70 x 50 mm A 50 21Gx2 0 80 x 50mm A 100 21G x 4 0 80 x 100 mm A 150 20G x 6 0 90 x 150 mm Contiplex A cannulae with 30 bevel 18G x 13 4 1 3x 45mm B02 1 3 x 55 mm Contiplex A Set with Contiplex Catheter 0 45 x 0 85 x 400 mm with cannula 18G x 13 4 1 3x 45mm with cannula 18G x 2 s 1 3x 55mm Alphapl
14. rve is consciously avoided PNS does not replace the anatomical knowledge re quired for regional anaesthesia rather it assumes accurate knowledge of the topography and the nerve distribution area The various types of nerve fibre differ in regard to their sensiti vity to electrical stimulation The A alpha motor fibres have the shortest chronaxia 50 100 us The fibres of pain sensation A delta and C fibres require a longer pulse 150 and 400 us respectively at minimum current Mixed peripheral nerves can be localized with short pulses 0 1 ms without triggering pain sensations For pure sensory nerves a longer pulse 0 3 or 1 0 ms is recommended Basic of Electrical Nerve Stimulation Depolarisation Threshold Level Action Potential action potential depolari sation time t ms theshold level resting potential action potential time t ms thesholdilevel repolarisation resting potential n NN eee When using unipolar needles needles with an insulated needle shaft and a conductive tip the current necessary to trigger muscular contractions pulse amplitude correlates with the distance of the tip of the needle from the nerve the lower the threshold current the more accurately is the nerve localized and the shorter the onset and more reliable the success of the block Needle tip more distant from the nerve Needle tip closer to the nerve Needle tip closer to the
15. s nerve by using pulse duration 1 0 mA Advantages from the latest digital technology Two different display modes E preset current mA current set mode read actual cur rent mA current read mode Impedance check E check of electric circuit by comparing present and ac tual current values High accuracy stimulation E direct high precision mea surement of current E precise rectangular pulse Shape For further details please refer to the user manual instructions for use Special needle coating E homogeneous and smooth surface from hub to tip E smooth puncture with ex cellent tactile feed back E complete coating of the needle results in a atrau matic tip Wide range of diffe rent types and sizes W covers practically all indi cations in plexus anaesthe sia E choice of 15 or 30 bevel according to your personal preference of puncture for ce and gliding characteri stics The high end in nerve stimulation Stimplex D needle The ideal pin point electrode currents Technical Data Instrument type Battery Power consuption Stimulation current Stimulation voltage Stimulation frequency Measuring tolerance Optional steam sterilizable control knob E convenient sterile operation of all functions E assisting staff is not necessary Stimuplex HNS 11 and Stimuplex D comple ment the well known and proven Stimuplex range with latest high end technology
16. sia Vol 19 No 2 S 74 a ae sees i Zenz M Glockner R 1981 Mehler D Otten B 1993 A new immobile needle for brachial plexus block A new set of catheters for continuous axillary plexus block Regional Anaesthesie 4 29 31 Regional Anaesthesie 6 43 46 B BRAUN HOSPITAL CARE B Braun Melsungen AG P O Box 11 20 D 34209 Melsungen Tel 49 5661 71 0 B 03 09 00 1 Nr 604 3437 Fax 49 5661 71 38 11 Printed on chlorine free bleached cellulose using 50 recycled paper www bbraun com
17. th highly flexible tip E atraumatic wire placement and safe catheter insertion New catheter tip design E smooth and atraumatic tip design Safe connection E kinking prevention due to the well proven Perifix catheter connector Alphaplex catheter sets acc to the Seldinger technique Insertion of the catheter via the Seldinger wire Contiplex D catheter sets acc to the Braunula technique The threading assist guide allows easy insertion of the plexus catheter through the 18G I V catheter Product Identification Product Type Nerve Stimulators cS Needles cannulae and sets for peripheral nerve stimulation The complete equipment on one glance Product Description Stimuplex HNS 11 with electrode cable for Stimuplex D Stimuplex A and Contiplex D needles Stimuplex DIG RC with integrated electrode cable for Stimuplex D Stimuplex A and Contiplex D needles Stimuplex D needles with 15 bevel D 25 035 25G lt a D 25055 256x21 D 26 040 23G x 11 2 D 26 070 23G x 23 4 D27050 22 G2 D 27 080 22G x 31 3 D 27 120 22G x 43 4 D 29 150 20G x 6 Stimuplex D needles with 30 bevel D 17 040 22G x 11 2 Daly 05022 G2 D 17 080 22G x 31 3 Contiplex D cannula with 15 bevel D 28 055 C 18G x 21 3 D 28 110 C 18 G x 43 3 Contiplex D cannula with 30 bevel D 18 055 C 18G x 21 3 Contiplex D Sets with Contiplex Cathete
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