Selective local anesthetic placement using ultrasound guidance and neurostimulation for infraclavicular brachial plexus block.

Bowens C, Gupta RK, O'Byrne WT, Schildcrout JS, Shi Y, Hawkins JJ, Michaels DR, Berry JM
Anesth Analg. 2010 110 (5): 1480-5

PMID: 20418309 · DOI:10.1213/ANE.0b013e3181d7e07e

BACKGROUND - In this study, we performed the infraclavicular block with combined ultrasound guidance and neurostimulation to selectively target cords to compare the success rates of placing a single injection of local anesthetic either in a central or peripheral location.

METHODS - Two hundred eighteen patients were enrolled in a consecutive, prospective study. Patients were randomized to injection of local anesthetic either centrally (posterior cord) or peripherally (medial or lateral cord) using ultrasound guidance and neurostimulation. Supervised senior anesthesiology residents or attending anesthesiologists performed the blocks. Both intent-to-treat and treatment-received analyses were used to compare central and peripheral placement efficacy.

RESULTS - The overall success rate was significantly higher for the central placements than peripheral placements (96% vs 85%, P = 0.004). Individual cord success rates were as follows: posterior 99%, lateral 92%, and medial 84% (P = 0.001). The central group required attending physician intervention more frequently (27% vs 6%, P < 0.001). Postoperative pain scores of < or =3 were more likely with central placement (100% vs 94%, P = 0.012).

CONCLUSION - Central placement of a single injection of local anesthetic targeted at the posterior cord resulted in a higher success rate for infraclavicular block.

MeSH Terms (23)

Adult Aged Anesthetics, Local Brachial Plexus Electric Stimulation Female Humans Logistic Models Male Middle Aged Monitoring, Intraoperative Movement Muscle, Skeletal Nerve Block Orthopedic Procedures Pain, Postoperative Prospective Studies Sensation Supine Position Treatment Outcome Ultrasonography Upper Extremity Young Adult

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