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Reviews
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What are the main claims of the paper and how important are they?
The low inter-scalene approach by Manani is an easy technique due to the constant anatomical structures ensuring a high success rate for shoulder and clavicle surgery.
This advantage should help to standardize the anaesthetic procedures for a team that deal with operative arthroscopy of the shoulder
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Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.
Yes
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Are the claims properly placed in the context of the previous literature?
Yes
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Do the results support the claims? If not, what other evidence is required?
Yes
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If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?
A multi center study would help to support the routine use of this technique.
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Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?
Yes
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Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?
It is not a randomized controlled trial
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Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?
Yes
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Other Comments:
It would be enough to repeat the experience in other centers and compare success rates and side effects;
Interesting for being simple and reproducible method -
Competing interests:
None
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Invited by the author to review this article? :
No -
Have you previously published on this or a similar topic?:
No
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References:
None
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Experience and credentials in the specific area of science:
None
- How to cite: Colonna U .A Simple Interscalene Block: The Manani's Technique. Some Elements of Distinction from Supraclavicular Perivascular Techniques. Review by Dr. Ugo Colonna[Review of the article 'A Simple Interscalene Block: The Manani's Technique. Some Elements of Distinction from Supraclavicular Perivascular Techniques ' by Zanette G].WebmedCentral 2013;4(5):WMCRW002744
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What are the main claims of the paper and how important are they?
The paper describes very well the Manani Interscalene Brachial Plexus Block Technique, emphasizing the anatomical landmarks (subclavian artery pulsation and inferior belly of omohyoid muscle) proper needle’s angles to perform the block and the anatomical spread of the local anesthetic solution. It also emphasizes the differences between supra-clavicular and interscalene approaches.
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Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.
They're not really novel, but there's a really detailed anatomical description in this paper
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Are the claims properly placed in the context of the previous literature?
Yes
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Do the results support the claims? If not, what other evidence is required?
The results support the claims. The authors describe well the landmarks, the needle penetration point on the skin and the average values of the needle's angles to the frontal and the transverse plane
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If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?
This is not a randomized trial. All patients received the same block.
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Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?
The methodology is valid and simple to perform.
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Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?
A randomised controlled comparison of the described block with other brachial plexus block techniques, in term of, for example, time for execution, volume of anesthetic solution, percentage of success in shoulder and humerus surgery and complications, could add more informations. Also a comparison between different local anesthetic solutions, i.e. ropivacaine vs bupivacaine, in term of duration of effect and onset time of anesthesia, could be interesting.
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Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?
I think it would be nice to present this technique to the anesthesiologists interested in loco-regional anesthesia.
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Other Comments:
In my experience the Manani's block is simple and fast to perform, it can provide an adequate anesthesia for shoulder and upper humerus surgery. The landmarks are easy to find also in obese patients. No major complications were observed in my experience (1 case of dyspnea in a COPD patient, due to phrenic unilateral block). The rate of success is high.
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Competing interests:
None
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Invited by the author to review this article? :
No -
Have you previously published on this or a similar topic?:
No
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References:
None -
Experience and credentials in the specific area of science:
Yes, I am skilled in locoregional anaesthesia techniques. I performed more than 100 brachial plexus blocks using the Manani's technique.
- How to cite: Baltieri L .Revie on A Simple Interscalene Block: The Manani's Technique. Some Elements of Distinction from Supraclavicular Perivascular Techniques [Review of the article 'A Simple Interscalene Block: The Manani's Technique. Some Elements of Distinction from Supraclavicular Perivascular Techniques ' by Zanette G].WebmedCentral 2013;4(5):WMCRW002711
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What are the main claims of the paper and how important are they?
The paper deeply describes the already known“Manani” Interscalene Brachial Plexus Block Technique, emphasizing the proper needle’s angles to perform the block, the quality and the anatomical distribution of the block.
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Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.
These claims are not completely novel and partially described by the same authors, but in not-indexed papers (see references 4-7). But for the first time this new paper clarifies specifically the point of needle penetration, the needle direction (neddle's angles in respect of the frontal and the transverse planes) and its relationship with the inferior belly of omohyoid muscle. This adds useful information for the practitioners and provides new insight for a better performance of this block.
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Are the claims properly placed in the context of the previous literature?
The claims are well supported and properly placed.
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Do the results support the claims? If not, what other evidence is required?
The results support the claims, well defining the average values of the needle's angles to the frontal and the transverse plane for a proper block.
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If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?
A standard Manani's interscalene block technique has been performed for all the patients, but the study is not a randomized controlled trial.
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Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?
Authors minutely describe this peripheral block that offers a complete anesthesia of the cervical plexus' lowest roots and the brachial plexus' highest roots. This condition is necessary to perform shoulder and clavicle surgery. Following Authors' indications, this block could be reproduced.
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Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?
This paper is a descriptive prospective study about a peripheral block technique. A randomised controlled comparison of the described block with other Supraclavicular Perivascular Brachial Plexus Block Techniques, in term of percentage of success in shoulder and humerus surgery could add more informations.
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Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?
The paper cannot be considered outstanding, but original, definitely.
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Other Comments:
In particular in a “ultrasound-guided regional anesthesia” age, this simple technique can be useful in many situations where just traditional nerve localization techniques, i.e. peripheral nerve stimulation, are possible. For example when or where an adequate and compatible power supply to operate ultrasound equipment or the essential skill to perform ultrasound-guided block are still missing. And the already mentioned well described details in performing the block render the Manani's technique easier.
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Competing interests:
None
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Invited by the author to review this article? :
Yes -
Have you previously published on this or a similar topic?:
Yes
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References:
Minerva Anestesiol 2007;73:529-531
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Experience and credentials in the specific area of science:
Yes, I am skilled in locoregional anaesthesia techniques
- How to cite: Micaglio M .A Simple Interscalene Block: The Manani's Technique. Some Elements of Distinction from Supraclavicular Perivascular Techniques [Review of the article 'A Simple Interscalene Block: The Manani's Technique. Some Elements of Distinction from Supraclavicular Perivascular Techniques ' by Zanette G].WebmedCentral 2013;4(4):WMCRW002709
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Main claims of this paper is a better definition of anatomical landmarks for the performance of an interesting regional anaesthesia (RA) techniques to perform shoulder surgery.
These claims are not novel, but this paper improves the feasibility of this interscalene block in a high-tech Ultra Sound RA guided time; this simple technique may be very useful in a low-tech low expensive RA setting, like developing country; in this bad economic era, this simple technique may be reconsidered as a low cost high effective technique.
Yes
Yes
There are not deviations from the protocol
Yes, it is
No, the study is well designed and correctly performed
Yes, it is
This paper improve the description of an already known and described RA tecnique: the brachial plexus block performed following the Manani technique.
I use often this technique with excellent clinical results.
0
No
Yes
Zanette G, Facco E., Micaglio M, Armellin G, Manani G. Myotonia congenita and regional anaesthesia with peripheral nerve stimulation: a case report. Minerva Anaestesiol, 2007; 73: 529-31
I perform routinely RA techniques