Comparison of two approaches of infraclavicular brachial plexus block for orthopaedic surgery below mid-humerus

Vikas Trehan, Uma Srivastava, Aditya Kumar, Surekha Saxena, Chandra Sekar Singh, Ankit Darolia, Vikas Trehan, Uma Srivastava, Aditya Kumar, Surekha Saxena, Chandra Sekar Singh, Ankit Darolia

Abstract

The brachial plexus in infraclavicular region can be blocked by various approaches. Aim of this study was to compare two approaches (coracoid and clavicular) regarding success rate, discomfort during performance of block, tourniquet tolerance and complications. The study was randomised, prospective and observer blinded. Sixty adult patients of both sexes of ASA status 1 and 2 requiring orthopaedic surgery below mid-humerus were randomly assigned to receive nerve stimulator guided infraclavicular brachial plexus block either by lateral coracoid approach (group L, n = 30) or medial clavicular approach (group M, n = 30) with 25-30 ml of 0.5% bupivacaine. Sensory block in the distribution of five main nerves distal to elbow, motor block (Grade 1-4), discomfort during performance of block and tourniquet pain were recorded by a blinded observer. Clinical success of block was defined as the block sufficient to perform the surgery without any supplementation. All the five nerves distal to elbow were blocked in 77 and 67% patients in groups L and M respectively. Successful block was observed in 87 and 73% patients in groups L and M, respectively (P > 0.05). More patients had moderate to severe discomfort during performance of block due to positioning of limb in group M (14 vs. 8 in groups M and L). Tourniquet was well tolerated in most patients with successful block in both groups. No serious complication was observed. Both the approaches were equivalent regarding success rate, tourniquet tolerance and safety. Coracoid approach seemed better as positioning of operative limb was less painful, coracoids process was easy to locate and the technique was easy to learn and master.

Keywords: Coracoid approach; infraclavicular brachial plexus block; mid-clavicular approach.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Raj PP, Montgomery SJ, Nettles D, Jenkins MT. Infraclavicular brachial plexus block: A new approach. Anesth Analg. 1973;52:897–904.
    1. Desroches J. The infraclavicular brachial plexus block by the coracoid approach is clinically effective: An observational study of 150 patients. Can J Anaesth. 2003;50:253–7.
    1. Klaastad O, Lilleås FG, Røtnes JS, Breivik H, Fosse E. Magnetic resonance imaging demonstrates lack of precision in needle placement by the infraclavicular brachial plexus block described by Raj et al. Anesth Analg. 1999;88:593–8.
    1. Kilka HG, Geiger P, Mehrkens HH. Infraclavicular vertical brachial plexus blockade. A new method for anesthesia of the upper extremity. An anatomical and clinical study. 1995;44:339–44.
    1. Wilson JL, Brown DL, Wong GY, Ehman RL, Cahill DR. Infraclavicular brachial plexus block: Parasagittal anatomy important to the coracoid technique. Anesth Analg. 1998;87:870–3.
    1. Kapral S, Jandrasits O, Schabernig C, Likar R, Reddy B, Mayer N, et al. Lateral infraclavicular plexus block vs. axillary block for hand and forearm surgery. Acta Anaesthesiol Scand. 1999;43:1047–52.
    1. Borgeat A, Ekatodramis G, Dumont C. An evaluation of the infraclavicular block via a modified approach of the Raj technique. Anesth Analg. 2001;93:436–41.
    1. Jandard C, Gentili ME, Girard F, Ecoffey C, Heck M, Laxenaire MC, et al. Infraclavicular block with lateral approach and nerve stimulation: Extent of anesthesia and adverse effects. Reg Anesth Pain Med. 2002;27:37–42.
    1. Sauter AR, Dodgson MS, Stubhaug A, Halstensen AM, Klaastad O. Electrical nerve stimulation or ultrasound guidance for lateral sagittal infraclavicular block: A randomized, controlled, observer-blinded, comparative study. Anesth Analg. 2008;106:1910–5.
    1. Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJ, Franco CD, et al. Upper extremity regional anesthesia: Essentials of our current understanding, 2008. Reg Anesth Pain Med. 2009;34:134–70.
    1. Gaertner E, Estebe JP, Zamfir A, Cuby C, Macaire P. Infraclavicular plexus block: Multiple injection versus single injection. Reg Anesth Pain Med. 2002;27:590–4.
    1. Ootaki C, Hayashi H, Amano M. Ultrasound-guided infraclavicular brachial plexus block: An altlernative technique to anatomical landmark-guided approaches. Reg Anesth Pain Med. 2000;25:600–4.
    1. Rodriguez J, Barcena M, Taboada-Muniz M, Lagunilla J, Alvarez J. A comparison of single versus multiple injections on the extent of anesthesia with coracoid infraclaviculalr brachial plexus block. Anesth Analg. 2004;99:1225–30.
    1. Porter JM, McCartney CJ, Chan VW. Needle placement and injection posterior to the axillary artery may predict successful infraclavicular brachial plexus block: A report of three cases. Can J Anaesth. 2005;52:69–73.
    1. Sandhu NS, Capan LM. Ultrasound-guided infraclavicular brachial plexus block. Br J Anaesth. 2002;89:254–9.
    1. Lecamwasam H, Mayfield J, Rosow L, Chang Y, Carter C, Rosow C. Stimulation of the posterior cord predicts successful infraclavicular block. Anesth Analg. 2006;102:1564–8.
    1. Minville V, N’Guyen L, Chassery C, Zetlaoui P, Pourrut JC, Gris C, et al. A modified coracoid approach to infraclavicular brachial plexus blocks using a double-stimulation technique in 300 patients. Anesth Analg. 2005;100:263–5.
    1. Minville V, Fourcade O, Bourdet B, Doherty M, Chassery C, Pourrut JC, et al. The optimal motor response for infraclavicular brachial plexus block. Anesth Analg. 2007;104:448–51.
    1. Bigeleisen P, Wilson M. A comparison of two techniques for ultrasound guided infraclavicular block. Br J Anaesth. 2006;96:502–7.
    1. Morimoto M, Popovic J, Kim JT, Kiamzon H, Rosenberg AD. Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks. Can J Anaesth. 2007;54:1006–10.
    1. Crews JC, Gerancher JC, Weller RS. Pneumothorax after coracoid infraclavicular brachial plexus block. Anesth Analg. 2007;105:275–7.
    1. Sanchez HB, Mariano ER, Abrams R, Meunier M. Pneumothorax following infraclavicular brachial plexus block for hand surgery. Orthopedics. 2008;31:709.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj