Ultrasound-guided infraclavicular brachial plexus block improves the success rate in patients with radial club hands when compared with nerve stimulation in patients undergoing radial club hand correction.

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After a quadratus lumborum (QL) block, the course of QL plane catheter is unpredictable. This case series discusses the course and fate of trans-muscular QL catheters by following and discussing the contrast spread through the fascial planes. Intrao-peratively, the catheters were tracked by the surgeons and were checked for integrity of anterior thoracolumbar fascia (ATLF) by injecting sterile 0.9% saline. The ATLF was intact upon injection and there was cephalad and medial saline spread with slight bulging of ATLF. On day 3 after written informed consent from all patients, computed tomography (CT) contrast studies were performed. Post-operative contrast spread was variable and was visualised in transversus abdominis plane, QL plane, lower thoracic paravertebral space, inter-vertebral foramina and anterior epidural space. CT contrast images demonstrated a variable spread. In conclusion, injection in ATLF of QL can spread along the path of least resistance and is unpredictable.

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After institutional ethics committee approval and informed consent, 20 patients with clavicle fractures were recruited. An ultrasound-guided C5 root block was performed by injecting 3 mL of 0.5% bupivacaine with a subsequent ultrasound-guided supraclavicular nerve (SCN) block with 3 mL of 0.5% bupivacaine. A combination of low-volume C5 root block and SCN block provided reliable awake anesthesia and postoperative analgesia in patients with fractured clavicles. This technique can avoid a general anesthesia for fractures of the mid and lateral clavicle. Further studies should focus on the optimal volume of local anesthetics required for the success of this technique.

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