Objective

To describe the anatomy of the brachial plexus in eastern box turtles (Terrapene carolina carolina), develop a blind perineural injection technique for brachial plexus blockade and evaluate the distribution of three volumes of new methylene blue dye for injection in cadavers.

Study design

Prospective, randomized, blinded cadaveric study.

Animals

A total of 24 frozen-thawed box turtle cadavers; two turtles identified with shoulder injuries were subsequently excluded from the study. The remaining 22 turtles weighed 397 (190–581) g, median (range).

Methods

The brachial plexus and regional anatomy were identified by dissection of seven cadavers to determine anatomic landmarks for a perineural injection technique. This technique was tested by randomizing 15 cadavers into one of three groups to be injected bilaterally with one of three volumes (0.1, 0.2 or 0.3 mL) of methylene blue dye 1% aqueous solution. Investigators blinded to the assigned group dissected cadavers 15 minutes after injection and used staining of the four cervical spinal nerves (C5–C8; 25% for each nerve) to record a staining score of the brachial plexus (0–100%).

Results

Based on descriptions of the anatomy of the brachial plexus, an injection technique was designed. Injections of 0.1 mL methylene blue dye resulted in nine/10 injections with 100% nerve stained, and one/10 injection with 50% (two) nerves stained. All injections of 0.2 or 0.3 mL of methylene blue dye resulted in 100% nerves stained.

Conclusions and clinical relevance

Perineural injection of the brachial plexus with 0.1, 0.2 or 0.3 mL methylene blue dye was successful in 29/30 injections in box turtle cadavers weighing 190–581 g. Further studies are needed to determine the minimum volume of injectate that can be successfully used for this technique, and to evaluate its application and efficacy in live turtles.

中文翻译：

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盲注技术用于东部箱龟（Terrapene carolina carolina）臂丛神经阻滞的可行性：一项尸体研究

客观的

为了描述东部箱龟 ( Terrapene carolina carolina )臂丛神经的解剖结构，开发了一种用于臂丛神经阻滞的神经周围盲注射技术，并评估了三卷新亚甲蓝染料在尸体中的分布情况。

学习规划

前瞻性、随机、盲法尸体研究。

动物

冻融箱龟尸体共24具；两只肩部受伤的海龟随后被排除在研究之外。其余 22 只海龟的体重为 397 (190–581) g，中位数（范围）。

方法

通过解剖七具尸体来确定臂丛神经和区域解剖结构，以确定神经周围注射技术的解剖标志。通过将 15 具尸体随机分为三组之一进行测试，以进行双侧注射三倍体积（0.1、0.2 或 0.3 mL）的亚甲蓝染料 1% 水溶液之一。对指定组不知情的研究人员在注射后 15 分钟解剖尸体，并使用四个颈椎神经（C5-C8；每条神经 25%）的染色来记录臂丛神经的染色评分（0-100%）。

结果

根据对臂丛神经解剖结构的描述，设计了一种注射技术。注射 0.1 mL 亚甲蓝染料导致 100% 神经染色的 9/10 注射和 50%（2）神经染色的 1/10 注射。0.2 或 0.3 mL 亚甲蓝染料的所有注射均导致 100% 的神经染色。

结论和临床相关性

臂丛神经周围注射 0.1、0.2 或 0.3 mL 亚甲蓝染料在 29/30 体重 190–581 g 的箱龟尸体中成功注射。需要进一步研究以确定可成功用于该技术的最小注射量，并评估其在活海龟中的应用和功效。