title: A comparison of a single-stimulation lateral infraclavicular plexus block with a triple-stimulation axillary block.
abstract: OBJECTIVE
  A single-stimulation infraclavicular brachial plexus block (ICB) is safe and easy to perform, although underused. This technique was compared with a triple-stimulation axillary block (AxB).
  
  
  METHODS
  One hundred patients scheduled for hand and forearm surgery were randomly allocated to 2 groups. ICB was performed with the needle inserted above the coracoid process in the upper lateral angle of the infraclavicular fossa and directed vertically until nerve stimulation elicited a distal motor response (median, radial, or ulnar). A single 40-mL bolus of ropivacaine 0.75% was injected. In the AxB group, 3 stimulations were performed to identify median or ulnar, radial, and musculocutaneous nerves, followed by an infiltration near the medial brachial and antebrachial cutaneous nerves. The same 40 mL of ropivacaine 0.75% was injected. Sensory and motor blocks were assessed at 5-minute intervals over 30 minutes.
  
  
  RESULTS
  The time to block performance was shorter in the ICB than in the AxB group (2.5 +/- 1.9 minutes v 6.0 +/- 2.8 minutes, P <.001). The success rate (complete block in median, radial, ulnar, musculocutaneous, and medial antebrachial cutaneous nerves) was comparable in the 2 groups (90% v 88% in groups ICB and AxB, respectively). Block extension was comparable, except for a higher rate of block completion in the axillary nerve distribution in group ICB and in the medial brachial cutaneous nerve in group AxB. The onset of each nerve block was comparable except for a faster onset for the musculocutaneous nerve in group AxB (8 +/- 3 v 10 +/- 5 minutes).
  
  
  CONCLUSIONS
  A single shot ICB is equally effective as a triple-nerve stimulation AxB.
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Deleuze
authors.forename: Marc E
authors.initials: ME
authors.lastname: Gentili
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Marret
authors.forename: Laurent
authors.initials: L
authors.lastname: Lamonerie
authors.forename: Francis
authors.initials: F
authors.lastname: Bonnet
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides; D000779:Anesthetics, Local; D001365:Axilla; D001917:Brachial Plexus; D004558:Electric Stimulation; D005260:Female; D005542:Forearm / Q000601:surgery; D006225:Hand / Q000601:surgery; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000502:physiology; D008875:Middle Aged; D009407:Nerve Block; D019637:Orthopedic Procedures; D010147:Pain Measurement; D011826:Radial Nerve / Q000502:physiology; D000077212:Ropivacaine; D014459:Ulnar Nerve / Q000502:physiology
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine