The Optimal Motor Response for Infraclavicular Brachial Plexus Block

Minville, Vincent; Fourcade, Olivier; Bourdet, B.; Doherty, Mary; Chassery, Clément; Pourrut, Jean-Claude; Gris, Claude; Eychennes, Bernard; Colombani, Aline; Samii, Kamran; Bouaziz, Hervé

doi:10.1213/01.ane.0000253235.39696.fa

Cited by 23 publications

(8 citation statements)

References 8 publications

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“…In contrast to this, large case series have shown that a radial-type response yields a higher success rate than median-or ulnar-type response. 13,14 However, the conclusions of these studies are not applicable to more proximal VIB and vice versa, mainly because of the fact that a lateral (pericoracoid) approach to infraclavicular blockade implies a difference in cord topography.…”

Section: Discussionmentioning

confidence: 99%

Vertical Infraclavicular Brachial Plexus Block

Moayeri

Renes

Geffen

et al. 2009

Regional Anesthesia and Pain Medicine

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Section: Discussionmentioning

confidence: 99%

Vertical Infraclavicular Brachial Plexus Block

Moayeri

Renes

Geffen

et al. 2009

Regional Anesthesia and Pain Medicine

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“…[28] Secondly, when distal response is obtained, the needle is more centrally placed, resulting in even diffusion of local anaesthetic. [271416] Some authors emphasise that double or multiple stimulation[111718] improves success rate of ICPB, whereas others suggest that stimulation of median nerve,[13] posterior cord[16] or all three cords[11] causes less chances of failure.…”

Section: Discussionmentioning

confidence: 99%

“…This was probably due to more lateral approach in group L and angulated direction of needle in group M. Our results are in agreement with other studies. [5781718]…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2010

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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.

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“…These investigators registered a 5.8% failure after single injection to the posterior cord compared to 28% following a motor response to the lateral cord. Similarly Minville identified a higher (96%) success rate following a radial motor response compared to 89% and 90% success rates after median or ulnar responses, respectively (Minville et al, 2007). Porter et al published similar findings at the axillary level, arguing that needle placement and injection posterior to the axillary artery may predict successful infraclavicular block (Porter et al, 2005).…”

Section: An Important Anatomical Impingement Pointmentioning

confidence: 92%

Regional anesthesia and pain management: What's new

Urmey

2008

Eur Journal of Pain Supp

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Present technological advances allow more accurate needle/catheter placement. Continuous regional analgesia with perineural catheters has been shown to significantly improve outcome. Grossi introduced the “anesthetic line” concept as a guide for approaches to perineural regional anesthesia. Winnie introduced the concept of the brachial plexus sheath that envelops the neural or neurovascular plexus. He discussed similar sheathes applying to the lower extremity. Recent studies support his sheath theory. Anatomical as well as local anesthetic distribution studies support a new concept that has relevant clinical applications. This concept is the presence of an anatomical impingement point at the junction of the clavicle and first rib that acts as a functional point of resistance to the flow of an injectate beyond this point. Similarly, it restricts the advancement of a catheter. The brachial plexus should be thought of as an hourglass‐shaped anatomical compartment with the narrow portion of the hourglass at the costoclavicular junction. Above the clavicle the compartment is triangular and flat. Below the clavicle a larger cylindrical half‐hourglass shape prevails. Injections above and or below the clavicle lead to different anesthetic distributions as well as clinical results. This anatomy will continue to be elucidated and must be kept in mind when targeting anesthesia or analgesia by single or multiple injections and for optimal placement of catheter or catheters for continuous infusions.

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The Optimal Motor Response for Infraclavicular Brachial Plexus Block

Abstract: We conclude that having initially located and blocked the musculocutaneous nerve, subsequent injection on a radial response resulted in a slightly more reliable success rate than injection with an ulnar or median response.

Cited by 23 publications

References 8 publications

Vertical Infraclavicular Brachial Plexus Block

Vertical Infraclavicular Brachial Plexus Block

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

Regional anesthesia and pain management: What's new

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