JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lecamwasam, H. Articles by Rosow, C. Search for Related Content PubMed PubMed Citation Articles by Lecamwasam, H. Articles by Rosow, C. Related Collections Anesthetic Techniques Regional Anesthesia

---

REGIONAL ANESTHESIA

Stimulation of the Posterior Cord Predicts Successful Infraclavicular Block

Department of Anesthesia and Critical Care, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta, Georgia

Address correspondence and reprint requests to Carl Rosow, MD, PhD, Department of Anesthesia and Critical Care, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114. Address e-mail to crosow{at}partners.org.

Infraclavicular (IC) block is often performed by localizing one cord within the brachial plexus sheath and placing all the local anesthetic solution at that location. We hypothesized that posterior cord stimulation would be associated with a greater likelihood of IC block success. We enrolled 369 patients scheduled for surgery to the lower arm or hand in a prospective, nonrandomized observational trial. All underwent IC blocks using a standard technique, and the cord stimulated immediately before drug injection was recorded. Motor and sensory functioning were evaluated 15 min after injection. Compared with stimulation of either the lateral or medial cord, stimulation of the posterior cord was associated with rapid onset of motor block in significantly more nerves, as well as a decreased likelihood of block failure (motor and sensory block inadequate to perform surgery). Failure rates were 5.8% for posterior cord, 28.3% for lateral (P < 0.05), and 15.4% for medial (P < 0.05). The differences were highly significant when adjusted for multiple possible confounders, such as gender, body mass index, location of the incision, and level of training of the individual performing the block (P < 0.001, lateral versus posterior; P = 0.003, medial versus posterior). A low failure rate was also predicted by stimulation of more than one cord simultaneously (P < 0.05). We conclude that injection after locating the posterior cord or multiple cords predicts successful IC block.

This article has been cited by other articles:

				S. Levesque, N. Dion, and M.-C. Desgagne Endpoint for successful, ultrasoundguided infraclavicular brachial plexus block Can J Anesth, May 1, 2008; 55(5): 308 - 308. [Full Text] [PDF]

				M. Morimoto, J. Popovic, J. T. Kim, H. Kiamzon, and A. D. Rosenberg Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks: [Les septa peuvent influencer la diffusion de l'anesthesique local durant les blocs infraclaviculaires du plexus brachial] Can J Anesth, December 1, 2007; 54(12): 1006 - 1010. [Abstract] [Full Text] [PDF]

				Q. H. De Tran, A. Clemente, J. Doan, and R. J. Finlayson Brachial plexus blocks: a review of approaches and techniques: [Les blocs du plexus brachial : compte-rendu des approches et techniques] Can J Anesth, August 1, 2007; 54(8): 662 - 674. [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]

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