Comparison of 3 ultrasound-guided brachial plexus block approaches for cubital tunnel release surgery in 120 ambulatory patients.

We wanted to determine whether 1 of 3 brachial plexus blocks was best for one of our most common surgeries, the cubital tunnel release with or without transposition of the ulnar nerve. Brachial plexus blocks can provide excellent results for upper extremity surgery, but we noticed inexplicable block failure for cubital tunnel releases with an incision in the proximal arm. In this case series, we initially reviewed 90 patients receiving axillary, infraclavicular, or supraclavicular blocks to determine if one block performed better for a surgical procedure that proceeds up the inner aspect of the arm. The theory that infraclavicular and supraclavicular blocks were superior for this surgery was not demonstrated in these patients. Success was not determined by the block chosen; however, the intercostobrachial nerve may be inconsistently blocked because it is difficult to visualize on ultrasound. We subsequently reviewed 30 more patients, but this time the volume of the intercostobrachial block was doubled. By increasing the volume, there appeared to be less need for surgeons to "touch up" blocks in the operating room. We suggest that increasing the volume of the intercostobrachial nerve block may improve success. Further studies to identify the intercostobrachial nerve by ultrasound are needed.