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REGIONAL ANESTHESIA

Ultrasound-Guided Infraclavicular Versus Supraclavicular Block

Geneviève Arcand, MD^*, Stephan R. Williams, MD, PhD, FRCPC^*, Philippe Chouinard, MD, FRCPC^*, Daniel Boudreault, MD, FRCPC^*, Patrick Harris, MD, FRCSC, Monique Ruel, RN, CCRP^*, and François Girard, MD, FRCPC^*

Departments of *Anesthesiology and Surgery, Centre Hospitalier de l’Université de Montréal, Hôpital Notre-Dame, Montréal, Canada

Address correspondence to Stephan Williams, MD, PhD, FRCPC, Department of Anesthesiology, CHUM, Hôpital Notre-Dame, 1560 Sherbrooke east, Montreal, Canada, H2L 4M1. Address e-mail to stephan.williams{at}umontreal.ca.

In this prospective study we compared ultrasound-guided (USG) infraclavicular and supraclavicular blocks for performance time and quality of block. We hypothesized that the infraclavicular approach would result in shorter performance times with a quality of block similar to that of the supraclavicular approach. Eighty patients were randomized into two equal groups: Group I (infraclavicular) and Group S (supraclavicular). All blocks were performed using ultrasound visualization with a 7.5-MHz linear probe and neurostimulation. The anesthetic mixture consisted of 0.5 mL/kg of bupivacaine 0.5% and lidocaine hydrocarbonate 2% (1:3 vol.) with epinephrine 1:200,000. Sensory block, motor block, and supplementation rates were evaluated for the musculocutaneous, median, radial, and ulnar nerves. Surgical anesthesia without supplementation was achieved in 80% of patients in group I compared with 87% in Group S (P = 0.39). Supplementation rates were significantly different only for the radial territory: 18% in Group I versus 0% in group S (P = 0.006). Block performance times were not different between groups (4.0 min in Group I versus 4.65 min in Group S; P = 0.43). Technique-related pain scores were not different between groups (I: 2.0; S: 2.0; P = 1.00). We conclude that USG infraclavicular block is at least as rapidly executed as USG supraclavicular block and produces a similar degree of surgical anesthesia without supplementation.

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