Infraclavicular Brachial Plexus Block???A New Approach

Raj, P. Prithvi; Montgomery, S. J.; Nettles, D.; Jenkins, M. T.

doi:10.1213/00000539-197311000-00007

Cited by 206 publications

(80 citation statements)

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“…1 It was not until 1973 that a new infraclavicular approach was introduced by Raj. 2 Raj considered that the axillary approach had certain limitations that he expressed as follows: 1) the block can only be performed when the arm is abducted to 90 or more; 2) it is difficult to block the musculocutaneous and axillary nerves; 3) whenever a tourniquet is to be used, the intercostobrachial nerve has to be blocked by additionnal infiltration. The infraclavicular approach was developed in the hope to overcome these limitations, but widespread use of Raj's infraclavicular brachial approach seems not to have materialized.…”

mentioning

confidence: 99%

The infraclavicular brachial plexus block by the coracoid approach is clinically effective: an observational study of 150 patients

Desroches

2003

Can J Anesth/J Can Anesth

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mentioning

confidence: 99%

The infraclavicular brachial plexus block by the coracoid approach is clinically effective: an observational study of 150 patients

Desroches

2003

Can J Anesth/J Can Anesth

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“…We hypothesized that ultrasound guidance increases the success rate of infraclavicular block from 68% [1][2][3][4][5][6] to 90% compared with a dual endpoint stimulation technique. Assuming a = 0.05 and b = 0.2 required a sample size of 106 patients (53 per group).…”

Section: Discussionmentioning

confidence: 99%

“…While various nerve stimulator-guided approaches to infraclavicular block have been described in the literature, [1][2][3][4][5][6] success rates reportedly range from only 60 to 79%. The highest success rate is associated with multiple-cord stimulation, 3,5,6 such that the elicitation of motor twitches corresponding to at least two cords (i.e., dual motor endpoint) is the most reliable goal for traditional nerve stimulator-guided infraclavicular block.…”

Section: Résumémentioning

confidence: 99%

Compared with dual nerve stimulation, ultrasound guidance shortens the time for infraclavicular block performance

Brull

Lupu

Perlas

et al. 2009

Can J Anesth/J Can Anesth

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Purpose The success rate for infraclavicular brachial plexus block using nerve stimulation reportedly ranges from 60 to 80%. Ultrasound guidance may be associated with greater success. This study compared ultrasound guided infraclavicular block with a dual motor endpoint nerve stimulation technique. Methods One hundred three hand surgery patients were randomized to receive either ultrasound-guided (ultrasound group) or dual motor endpoint nerve stimulation (stimulation group) infraclavicular block using 2% lidocaine 15 mL and 0.5% bupivacaine 15 mL with epinephrine. Block success was defined as loss of sensation to pinprick in each of the radial, ulnar, median, and musculocutaneous nerve distributions when measured 20 min after block performance. Block performance time, readiness for surgery (no supplemental block, skin infiltration, or general anesthesia), and complications were also assessed.Results Patient characteristics were similar between groups. Success rate was 92% in the ultrasound group and 80% in the stimulation group (P = 0.18). Block performance time was shorter in the ultrasound group (median 5 min) compared with the stimulation group (median 10.5 min) (P \ 0.001). Paresthesiae were more frequent in the stimulation group (45%) than in the ultrasound group (6%) (P \ 0.001). After final injection, more patients were ready for surgery in the ultrasound group (85%) than in the stimulation group (65%) (P = 0.04). At 1 week postoperatively, complications were minor and transient and did not differ between groups. Conclusion There was no statistically significant difference in the success rate between ultrasound guidance and dual motor endpoint stimulation for infraclavicular block. However, ultrasound guidance shortens performance time and improves readiness for surgery compared with dual motor endpoint stimulation (Clinical Trial Registration Number: NCT00326261). RésuméObjectif Selon la litte´rature, le taux de re´ussite d'un bloc infraclaviculaire du plexus brachial re´alise´par stimulation nerveuse se situe entre 60 % et 80 %. L'e´choguidage pourrait eˆtre associe´a`un taux de re´ussite plus e´leve´. Cette e´tude a compare´un bloc infraclaviculaire re´alise´par e´choguidage a`une technique de double stimulation nerveuse des extre´mite´s motrices. Méthode Cent-trois patients devant subir une chirurgie de la main ont e´te´randomise´s à recevoir un bloc infraclaviculaire re´alise´soit par e´choguidage (groupe e´choguidage) ou par double stimulation nerveuse des extre´mite´s motrices (groupe stimulation) a`l'aide de 15 mL de lidocaı¨ne 2 % et de 15 mL de bupivacaı¨ne 0,5 % avec e´pine´phrine. La re´ussite du bloc a e´te´de´finie en tant que la

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“…İnfraklaviküler blok için Raj yaklaşımı, vertikal yaklaşım ve korakoid yaklaşım gibi farklı metotlarla uygulanabilir. [1][2][3] Vertikal yaklaşım ve korakoid yaklaşımlar blok uygulamasının kola özel pozisyon verilmesini gerektirmemesi nedeniyle travma hastalarında önemli bir avantaj sağlamaktadır. [2,3] Ameliyat odasının daha etkin kullanılabilmesi için hızlı blok yapma süresi ve hızlı etki başlama süresi de önemlidir; ayrıca ciddi komplikasyon riskinin en az olduğu yöntemin kullanılması uygundur.…”

Section: Introductionunclassified

A comparison of Vertical Infraclavicular and Coracoid Approaches in Forearm Surgery

Koltka¹,

Yenigün²,

Küçükgöncü³

et al. 2013

Agri

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SummaryObjectives: Despite several risks, infraclavicular approaches to the brachial plexus gained popularity. The present study compared success rates, block onset times, block performance times, and frequency of adverse effects of vertical infraclavicular (VIB) ÖzetAmaç: Çeşitli risklerine rağmen, brakiyal pleksusa infraklaviküler yaklaşımlar popülerlik kazanmıştır. Bu çalışmada, önkol cerrahisi uygulanan hastalarda vertikal infraklavikular (VİB) ve korakoid blokların (KB) başarı oranları, blok başlama zamanları, blok yapma zamanları ve olumsuz etkilerinin sıklığı karşılaştırıldı. Gereç ve Yöntem: Etik komite ve hasta onamı alındıktan sonra ön kol cerrahisi ameliyatı uygulanacak 40 hasta çalışmaya alındı. Brakiyal pleksus sinir stimulatörü ve kalem uçlu yalıtılmış iğne kullanılarak lokalize edildi. Blok için 30 ml %0.5 bupivakain kullanıldı. Bloklar ilk beş dakika boyunca dakikada bir, 15. dakikaya kadar beş dakikada bir ve sonrasında 15 dakikada bir ve ameliyatın sonunda değerlendirildi. Bulgular: Blok başlama zamanları gruplar arasında benzer değerlerde idi. 5, 10 ve 15. dakikalarda yapılan değerlendirmelerde Grup KB' de duysal blok daha derin idi. Ayrıca 5, 10, 15 ve 30. dakikalarda yapılan değerlendirmelerde Grup KB' de motor blok daha fazla idi. VİB yapılan hastalarda blok yapma zamanı daha kısa idi. Korakoid blok yapılan bir hastada genel anesteziye geçmek gerekti. Korakoid blok yapılan iki hastada damar ponksiyonu dışında başka yan etki saptanmadı. Sonuç: Korakoid blok ile daha yüksek oranlarda duysal ve motor blok benzer bir blok başlangıç zamanı ve ciddi bir komplikasyon olmaksızın sağlandı. KB, önkol cerrahisi için VİB'ye emin ve etkin bir alternatif olarak kabul edilebilir.Anahtar sözcükler: Korakoid blok; ön kol cerrahisi; vertikal infraklaviküler blok.

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Infraclavicular Brachial Plexus Block???A New Approach

Cited by 206 publications

References 0 publications

The infraclavicular brachial plexus block by the coracoid approach is clinically effective: an observational study of 150 patients

The infraclavicular brachial plexus block by the coracoid approach is clinically effective: an observational study of 150 patients

Compared with dual nerve stimulation, ultrasound guidance shortens the time for infraclavicular block performance

A comparison of Vertical Infraclavicular and Coracoid Approaches in Forearm Surgery

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