A Modified Coracoid Approach to Infraclavicular Brachial Plexus Blocks Using a Double-Stimulation Technique in 300 Patients

Abstract

Infraclavicular brachial plexus block is used less than other techniques of regional anesthesia for upper-limb surgery. We describe a modified coracoid approach to the infraclavicular brachial plexus using a double-stimulation technique and assess its efficacy. Patients undergoing orthopedic surgery of the upper limb were included in this prospective study. The landmarks used were the coracoid process and the clavicle. The needle was inserted in the direction of the top of the axillary fossa (in relation to the axillary artery), with an angle of 45 degrees. Using nerve stimulation, the musculocutaneous nerve was identified first and blocked with 10 mL of 1.5% lidocaine with 1:400,000 epinephrine. The needle was then withdrawn and redirected posteriorly and medially. The radial, ulnar, or median nerve was then blocked. The block was tested every 5 min for 30 min. The overall success rate, i.e., adequate sensory block in the 4 major nerve distributions at 30 min, was 92%, and 6% of the patients required supplementation. Five patients required general anesthesia. No major complications were observed. This modified infraclavicular brachial plexus block using a double-stimulation technique was easy to perform, had frequent success, and was safe in this cohort.

The Efficacy of Skin Temperature for Block Assessment After Infraclavicular Brachial Plexus Block

“…2,3 Lastly, we injected the musculocutaneuous nerve first, then either the radial, ulnar or median nerve. 5 It is not possible to know the effect of musculocutaneuous nerve injection on temperature in the other nerve distributions.…”

“…Infraclavicular brachial plexus block was performed as previously described. 5 Briefly, patients were placed in supine position with the head turned away from the arm to be anesthetized. The forearm was gently placed on the abdomen.…”

“…One-hundred-twenty nerves (30 patients, 4 nerves per patient) were anesthetized. The time to perform the block was 6 Ϯ 4 min and the onset time was 12 Ϯ 6 min (median: 10 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]). The second nerve response that was located after the musculocutaneous nerve was in the radial nerve in 40% of cases, in the ulnar nerve in 30% of cases, and in the median nerve in 30% of cases.…”

A comparison of Vertical Infraclavicular and Coracoid Approaches in Forearm Surgery

“…Minville ve ark. [9] korakoid blok için başarı oranını %92 olarak vermiştir ve %6 hastada ek lokal anestetik uygulanması gerektiğini ve sadece %2 hastada genel anestezi uygulandığını bildirmiştir. Rodríguez ve ark.…”

Single-Stimulation, Low-Volume Infraclavicular Plexus Block: Influence of the Evoked Distal Motor Response on Success Rate

“…[1][2][3][4][5][6][7] Recently, ICB techniques using the coracoid process as the main landmark were shown to be effective and safe approaches with infrequent complications. 8 However, the number of stimulations and the volume injected remain controversial. 9,10 Both low-volume and single-injection ICB are reputed to be associated with large variation in success rate ranging from 40% to 100%.…”