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REGIONAL ANESTHESIA

A Modified Coracoid Approach to Infraclavicular Brachial Plexus Blocks Using a Double-Stimulation Technique in 300 Patients

Vincent Minville, MD^*, Luc N'Guyen, MD^*, Clement Chassery, MD^*, Paul Zetlaoui, MD, Jean-Claude Pourrut, MD^*, Claude Gris, MD^*, Bernard Eychennes, MD^*, Dan Benhamou, MD, PhD, and Kamran Samii, MD, PhD^*

*Department of Anesthesiology and Intensive Care, Toulouse University Hospital; and Department of Anesthesiology and Intensive Care, Bicêtre University Hospital, Le Kremlin-Bicêtre, France

Address correspondence and reprint requests to Vincent Minville, MD, Department of Anesthesiology and Intensive Care, Toulouse University Hospital, France. Address e-mail to vincentminville{at}yahoo.fr

Infraclavicular brachial plexus block is used less than other techniques of regional anesthesia for upper-limb surgery. We describe a modified coracoid approach to the infraclavicular brachial plexus using a double-stimulation technique and assess its efficacy. Patients undergoing orthopedic surgery of the upper limb were included in this prospective study. The landmarks used were the coracoid process and the clavicle. The needle was inserted in the direction of the top of the axillary fossa (in relation to the axillary artery), with an angle of 45 degrees. Using nerve stimulation, the musculocutaneous nerve was identified first and blocked with 10 mL of 1.5% lidocaine with 1:400,000 epinephrine. The needle was then withdrawn and redirected posteriorly and medially. The radial, ulnar, or median nerve was then blocked. The block was tested every 5 min for 30 min. The overall success rate, i.e., adequate sensory block in the 4 major nerve distributions at 30 min, was 92%, and 6% of the patients required supplementation. Five patients required general anesthesia. No major complications were observed. This modified infraclavicular brachial plexus block using a double-stimulation technique was easy to perform, had frequent success, and was safe in this cohort.

IMPLICATIONS: In this study, a modified coracoid approach to the infraclavicular brachial plexus performed using a double-stimulation technique is described and its efficacy assessed. This modified approach had frequent success and was safe in this cohort.

This article has been cited by other articles:

				E. Dingemans, S. R. Williams, G. Arcand, P. Chouinard, P. Harris, M. Ruel, and F. Girard Neurostimulation in Ultrasound-Guided Infraclavicular Block: A Prospective Randomized Trial Anesth. Analg., May 1, 2007; 104(5): 1275 - 1280. [Abstract] [Full Text] [PDF]

				V. Minville, O. Fourcade, B. Bourdet, M. Doherty, C. Chassery, J.-C. Pourrut, C. Gris, B. Eychennes, A. Colombani, K. Samii, et al. The Optimal Motor Response for Infraclavicular Brachial Plexus Block Anesth. Analg., February 1, 2007; 104(2): 448 - 451. [Abstract] [Full Text] [PDF]

				V. Minville, O. Fourcade, L. Idabouk, J. Claassen, C. Chassery, L. Nguyen, J.-C. Pourrut, and D. Benhamou Infraclavicular brachial plexus block versus humeral block in trauma patients: a comparison of patient comfort. Anesth. Analg., March 1, 2006; 102(3): 912 - 915. [Abstract] [Full Text] [PDF]

				V. Minville, R. Amathieu, N. Luc, C. Gris, O. Fourcade, K. Samii, and D. Benhamou Infraclavicular Brachial Plexus Block Versus Humeral Approach: Comparison of Anesthetic Time and Efficacy Anesth. Analg., October 1, 2005; 101(4): 1198 - 1201. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999