title: Ultrasound-guided infraclavicular versus supraclavicular block.
abstract: In this prospective study we compared ultrasound-guided (USG) infraclavicular and supraclavicular blocks for performance time and quality of block. We hypothesized that the infraclavicular approach would result in shorter performance times with a quality of block similar to that of the supraclavicular approach. Eighty patients were randomized into two equal groups: Group I (infraclavicular) and Group S (supraclavicular). All blocks were performed using ultrasound visualization with a 7.5-MHz linear probe and neurostimulation. The anesthetic mixture consisted of 0.5 mL/kg of bupivacaine 0.5% and lidocaine hydrocarbonate 2% (1:3 vol.) with epinephrine 1:200,000. Sensory block, motor block, and supplementation rates were evaluated for the musculocutaneous, median, radial, and ulnar nerves. Surgical anesthesia without supplementation was achieved in 80% of patients in group I compared with 87% in Group S (P = 0.39). Supplementation rates were significantly different only for the radial territory: 18% in Group I versus 0% in group S (P = 0.006). Block performance times were not different between groups (4.0 min in Group I versus 4.65 min in Group S; P = 0.43). Technique-related pain scores were not different between groups (I: 2.0; S: 2.0; P = 1.00). We conclude that USG infraclavicular block is at least as rapidly executed as USG supraclavicular block and produces a similar degree of surgical anesthesia without supplementation.
authors.affiliation: Departments of *Anesthesiology and †Surgery, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Arcand
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Williams
authors.forename: Philippe
authors.initials: P
authors.lastname: Chouinard
authors.forename: Daniel
authors.initials: D
authors.lastname: Boudreault
authors.forename: Patrick
authors.initials: P
authors.lastname: Harris
authors.forename: Monique
authors.initials: M
authors.lastname: Ruel
authors.forename: François
authors.initials: F
authors.lastname: Girard
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D001132:Arm / Q000601:surgery; D001917:Brachial Plexus / Q000000981:diagnostic imaging*; D004558:Electric Stimulation; D005260:Female; D006225:Hand / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D019637:Orthopedic Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D010525:Peripheral Nerves / Q000187:drug effects; D011859:Radiography; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D000779:Anesthetics, Local