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REGIONAL ANESTHESIA

A Comparison of Single Versus Multiple Injections on the Extent of Anesthesia with Coracoid Infraclavicular Brachial Plexus Block

Department of Anesthesiology, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain

Address correspondence to Jaime Rodríguez, MD, PhD, Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Santiago, Travesía da Choupana, s.n. 15706, Santiago de Compostela, Spain. Address e-mail to jaimerodriguezgarcia{at}nacom.es

Single-injection coracoid infraclavicular brachial plexus block produces inconsistent anesthesia of the upper limb. In this study, we sought to determine the number of injections needed to provide a reasonably complete anesthesia of the upper limb with this approach. Seventy-five patients were randomly assigned to receive a coracoid block guided by nerve stimulator with 42 mL of 1.5% mepivacaine with a single-injection (Group 1), dual-injection (Group 2), or triple-injection (Group 3) technique. No search for a specific motor response was performed in any group. Sensory and motor block was assessed 5 and 20 min after the end of the injection of local anesthetic. Significantly less complete anesthesia to pinprick in the distributions of the axillary, musculocutaneous, radial, ulnar, and medial cutaneous forearm nerves was found in Group 1 at 20 min. Significantly less complete paralysis for arm, wrist, and hand movements was found in Group 1 at 20 min. No significant difference was found between Groups 2 and 3. We conclude that dual and triple injection of local anesthetic guided by nerve stimulator increases the efficacy of coracoid block when compared with a single-injection technique.

IMPLICATIONS: Both dual- and triple-injection infraclavicular coracoid block had better efficacy than a single-injection technique in providing anesthesia of the upper limb. Triple injection was not better than dual injection; therefore, the authors recommend dual-injection coracoid block.

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