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REGIONAL ANESTHESIA

A Simplified Approach to Vertical Infraclavicular Brachial Plexus Blockade Using Hand-Held Doppler

Steven Renes, MD^*, Laura Clark, MD, Mathieu Gielen, MD, PhD^*, Huub Spoormans, MD, Janneke Giele, MSc^*, and Anupama Wadhwa, MD

From the *Department of Anesthesiology, Radboud University Nijmegen Medical Center, The Netherlands; Department of Anesthesiology and Perioperative Medicine, University of Louisville, Kentucky; Department of Anesthesiology, Bernhoven Hospital Oss, The Netherlands; and Department of Anesthesiology and Perioperative Medicine, Outcomes Research Institute and University of Louisville, Kentucky.

Address correspondence and reprint requests to Steven Renes, MD, Department of Anesthesiology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Address e-mail to s.renes{at}anes.umcn.nl.

In this observational study, we used Doppler ultrasound during the performance of vertical infraclavicular brachial plexus blockade. The success rate at inserting the needle at the point where the sound of the subclavian artery via Doppler reached its maximum audibility was compared with that of the classical insertion point. In 89 of the 100 patients, the medial or posterior cord was found at first needle pass. Using the Doppler point for insertion resulted in a significantly more lateral entry point compared with the classical point (P < 0.001) and was associated with a high success rate of infraclavicular block.