Jean Desroches1. 1. Department of Anesthesia, Hôtel-Dieu de Saint-Jérôme, Saint-Jérôme, Québec, Canada. jean.desroches@sympatico.ca
Abstract
PURPOSE: To evaluate the sensory distribution, motor block and the clinical efficacy of the infraclavicular block by the coracoid approach. METHODS: In this prospective descriptive study, 150 patients received an infraclavicular block by the coracoid approach performed by a single anesthesiologist. Neurostimulation was used and 40 mL of mepivacaine 1.5% with adrenaline were injected. Block performance time, sensory distribution, motor block and tourniquet tolerance were evaluated. RESULTS: Time to perform the block was 5 +/- 2 min (mean +/- SD). Success rate defined as analgesia in the five nerves distal to the elbow (musculocutaneous, median, ulnar, radial and medial cutaneous nerve of the forearm) was 91% (137 patients). A proximal block of the axillary nerve was present in 98.5% of the patients and of the medial cutaneous nerve of the arm in 60%. An arm tourniquet ( 250 mmHg of pressure ) was applied to 115 of the 137 patients with a successful block and all tolerated the tourniquet for a duration of 37 +/- 21 min ( mean +/- SD). CONCLUSION: Infraclavicular block by the coracoid approach provides an extensive sensory distribution with an excellent tourniquet tolerance. We conclude that this approach provides highly consistent brachial plexus anesthesia for upper extremity surgery.
PURPOSE: To evaluate the sensory distribution, motor block and the clinical efficacy of the infraclavicular block by the coracoid approach. METHODS: In this prospective descriptive study, 150 patients received an infraclavicular block by the coracoid approach performed by a single anesthesiologist. Neurostimulation was used and 40 mL of mepivacaine 1.5% with adrenaline were injected. Block performance time, sensory distribution, motor block and tourniquet tolerance were evaluated. RESULTS: Time to perform the block was 5 +/- 2 min (mean +/- SD). Success rate defined as analgesia in the five nerves distal to the elbow (musculocutaneous, median, ulnar, radial and medial cutaneous nerve of the forearm) was 91% (137 patients). A proximal block of the axillary nerve was present in 98.5% of the patients and of the medial cutaneous nerve of the arm in 60%. An arm tourniquet ( 250 mmHg of pressure ) was applied to 115 of the 137 patients with a successful block and all tolerated the tourniquet for a duration of 37 +/- 21 min ( mean +/- SD). CONCLUSION:Infraclavicular block by the coracoid approach provides an extensive sensory distribution with an excellent tourniquet tolerance. We conclude that this approach provides highly consistent brachial plexus anesthesia for upper extremity surgery.
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