Safety and Efficacy of the Infraclavicular Nerve Block Performed at Low Current

Abstract

It has recently been suggested that peripheral nerve or plexus blocks performed with the use of a nerve stimulator at low currents (<0.5 mA) may result in neurologic damage. We studied the infraclavicular nerve block, performed with the use of a nerve stimulator and an insulated needle, in a prospective evaluation of efficacy and safety. During a one-year period, 248 patients undergoing infraclavicular nerve block were evaluated for block success rate and incidence of neurologic complication. All blocks were performed with the use of a nerve stimulator and an insulated needle at < or =0.3 mA. Success rate was 94%, which increased to 96% with surgical infiltration of local anesthetic. There were no intraoperative or immediate postoperative complications noted. After one week, only one patient had a neurologic complaint, and this was surgically related, referable to surgery performed on the radial nerve. We conclude that infraclavicular nerve blocks performed at low currents (< or =0.3 mA) are safe and effective.

A Technique for Ultrasound‐guided Paravertebral Brachial Plexus Injections in Dogs

“…The use of the scalenus muscle as a landmark was especially useful, as placement of contrast medium medial to the fascial plane helped contain the aliquot around the nerve roots. Other complications of brachial plexus blockade are due to long‐term nerve damage resulting from direct trauma or pressure necrosis 28,31,37,38 . Because cadavers were used in this study, it was not possible to assess that complication.…”

“…There can be clinical complications from brachial plexus anesthesia 28–32 . Diaphragmatic hemiparesis secondary to phrenic nerve anesthesia in humans, while rarely clinically significant, can be the result of C4 nerve root involvement or aberrant spread of anesthetic agent outside the prevertebral fascia of the anterior scalenus muscle, and is therefore dependent on the anatomic location of the needle and the volume of anesthetic used 27,32–38 .…”

Practice advisory on the bleeding risks for peripheral nerve and interfascial plane blockade: evidence review and expert consensus

“…In large ([ 200 patients) prospective and retrospective databases, the incidence of vascular puncture during infraclavicular block was noted to be between 0 and 6.6% with nerve stimulator guidance [40][41][42] while it was 0.7% with ultrasound guidance, 43 with no reports of hematoma formation.…”

Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years

“…Interestingly, there was no apparent difference in the incidence of complications between experienced and non-experienced operators. 45 The infraclavicular block was described as safe and effective when no intraoperative or immediate postoperative complications were noted by Keschner and colleagues 46 in 248 block procedures. Similar to the interscalene and supraclavicular approaches, reduced or paradoxical ipsilateral hemidiaphragmatic movement was observed (26%) and Horner's syndrome was seen in 12% of 35 patients.…”