title: Sonographically guided infraclavicular brachial plexus block in adults: a retrospective analysis of 1146 cases.
abstract: OBJECTIVE
  The aim of this study was to analyze our experience in 1146 cases of sonographically guided infraclavicular brachial plexus block (ICBPB) performed over 32 months.
  
  
  METHODS
  Anesthetic records of 1146 cases of sonographically guided ICBPB performed by our staff were studied retrospectively with the use of a database created by an automated anesthesia record-keeping system. The rates of successful blocks, failed blocks necessitating conversion to general anesthesia or requiring supplementation with local anesthetics, those requiring larger-than-usual doses of sedation, and complications were determined. Analysis included an attempt to determine the possible causes of inadequate blocks and complications.
  
  
  RESULTS
  In 1138 patients (99.3%), the block was successful. Six patients had incomplete blocks requiring general anesthesia, and another 2 patients needed local anesthetic supplementation by the surgeons. Ninety-seven percent of the blocks were performed by residents directly supervised by an attending anesthesiologist who held the ultrasound probe. The mean age+/-SD of the patients was 39+/-15 years; the mean duration of surgery was 165+/-114 minutes; and the male-female ratio was 4:1. More than 50% of patients were obese. There were no reported cases of nerve injury, pneumothorax, or local anesthetic toxicity. Arterial punctures occurred in 8 (0.7%) patients, but all were inconsequential.
  
  
  CONCLUSIONS
  The data from this retrospective study suggest that sonographic guidance provides a high success rate (99.3%) and improved safety for ICBPB. The increased operator team experience virtually eliminates failure and complications.
authors.affiliation: Department of Anesthesiology, New York University School of Medicine, New York, NY, USA. navparkashsandhu@hotmail.com
authors.forename: Navparkash S
authors.initials: NS
authors.lastname: Sandhu
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Manne
authors.forename: Praveen K
authors.initials: PK
authors.lastname: Medabalmi
authors.forename: Levon M
authors.initials: LM
authors.lastname: Capan
mesh_terms: D000328:Adult; D001917:Brachial Plexus / Q000000981:diagnostic imaging*; D002968:Clavicle; D005260:Female; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods*; D012189:Retrospective Studies; D014463:Ultrasonography