title: The optimal motor response for infraclavicular brachial plexus block.
abstract: BACKGROUND
  In this prospective study we compared the success of the infraclavicular brachial plexus block using double-stimulation in regard to the second nerve response elicited with neurostimulation.
  
  
  METHODS
  Six-hundred-twenty-eight patients undergoing emergency upper limb surgery using infraclavicular brachial plexus block were included in this study. The musculocutaneous nerve was initially blocked and the groups were then evaluated according to the second nerve located, which was radial in 54%, median in 35%, and ulnar in 11% of patients. Blocks were performed using lidocaine 1.5% with 1/400,000 epinephrine 40 mL in all cases. The block was assessed every 5 min for 30 min after completion of the block.
  
  
  RESULTS
  The success rate was 96% for the radial response group, 89% for the median response group, and 90% for the ulnar response group (P < 0.05). Time to perform the block and the onset time were not significantly different among groups. No serious complications were observed.
  
  
  CONCLUSIONS
  We conclude that having initially located and blocked the musculocutaneous nerve, subsequent injection on a radial response resulted in a slightly more reliable success rate than injection with an ulnar or median response.
authors.affiliation: Department of Anesthesiology and Intensive Care, Toulouse University Hospital, Toulouse, France. vincentminville@yahoo.fr
authors.forename: Vincent
authors.initials: V
authors.lastname: Minville
authors.forename: Olivier
authors.initials: O
authors.lastname: Fourcade
authors.forename: Benoît
authors.initials: B
authors.lastname: Bourdet
authors.forename: Mary
authors.initials: M
authors.lastname: Doherty
authors.forename: Clément
authors.initials: C
authors.lastname: Chassery
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: Aline
authors.initials: A
authors.lastname: Colombani
authors.forename: Kamran
authors.initials: K
authors.lastname: Samii
authors.forename: Hervé
authors.initials: H
authors.lastname: Bouaziz
mesh_terms: D000328:Adult; D000368:Aged; D001917:Brachial Plexus / Q000502:physiology*; D002968:Clavicle / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000502:physiology; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D009138:Musculocutaneous Nerve / Q000502:physiology; D009407:Nerve Block / Q000379:methods*; D011446:Prospective Studies; D011826:Radial Nerve / Q000502:physiology; D014459:Ulnar Nerve / Q000502:physiology