title: A modified coracoid approach to infraclavicular brachial plexus blocks using a double-stimulation technique in 300 patients.
abstract: Infraclavicular brachial plexus block is used less than other techniques of regional anesthesia for upper-limb surgery. We describe a modified coracoid approach to the infraclavicular brachial plexus using a double-stimulation technique and assess its efficacy. Patients undergoing orthopedic surgery of the upper limb were included in this prospective study. The landmarks used were the coracoid process and the clavicle. The needle was inserted in the direction of the top of the axillary fossa (in relation to the axillary artery), with an angle of 45 degrees. Using nerve stimulation, the musculocutaneous nerve was identified first and blocked with 10 mL of 1.5% lidocaine with 1:400,000 epinephrine. The needle was then withdrawn and redirected posteriorly and medially. The radial, ulnar, or median nerve was then blocked. The block was tested every 5 min for 30 min. The overall success rate, i.e., adequate sensory block in the 4 major nerve distributions at 30 min, was 92%, and 6% of the patients required supplementation. Five patients required general anesthesia. No major complications were observed. This modified infraclavicular brachial plexus block using a double-stimulation technique was easy to perform, had frequent success, and was safe in this cohort.
authors.affiliation: *Department of Anesthesiology and Intensive Care, Toulouse University Hospital; and †Department of Anesthesiology and Intensive Care, Bicêtre University Hospital, Le Kremlin-Bicêtre, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Minville
authors.forename: Luc
authors.initials: L
authors.lastname: NGuyen
authors.forename: Clement
authors.initials: C
authors.lastname: Chassery
authors.forename: Paul
authors.initials: P
authors.lastname: Zetlaoui
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Pourrut
authors.forename: Claude
authors.initials: C
authors.lastname: Gris
authors.forename: Bernard
authors.initials: B
authors.lastname: Eychennes
authors.forename: Dan
authors.initials: D
authors.lastname: Benhamou
authors.forename: Kamran
authors.initials: K
authors.lastname: Samii
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local; D001917:Brachial Plexus; D004558:Electric Stimulation; D004837:Epinephrine; D005260:Female; D006225:Hand / Q000601:surgery; D006801:Humans; D006811:Humerus / Q000601:surgery; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D019637:Orthopedic Procedures; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D004837:Epinephrine