title: Ultrasound-guided supraclavicular block: outcome of 510 consecutive cases.
abstract: BACKGROUND
  Supraclavicular brachial plexus block provides consistently effective anesthesia to the upper extremity. However, traditional nerve localization techniques may be associated with a high risk of pneumothorax. In the present study, we report block success and clinical outcome data from 510 consecutive patients who received an ultrasound-guided supraclavicular block for upper extremity surgery.
  
  
  METHODS
  After institutional review board approval, the outcome of 510 consecutive patients who received an ultrasound-guided supraclavicular block for upper extremity surgery was reviewed. Real-time ultrasound guidance was used with a high-frequency linear probe. The neurovascular structures were imaged on short axis, and the needle was inserted using an in-plane technique with either a medial-to-lateral or lateral-to-medial orientation.
  
  
  RESULTS
  Five hundred ten ultrasound-guided supraclavicular blocks were performed (50 inpatients, 460 outpatients) by 47 different operators at different levels of training over a 24-month period. Successful surgical anesthesia was achieved in 94.6% of patients after a single attempt; 2.8% required local anesthetic supplementation of a single peripheral nerve territory; and 2.6% received an unplanned general anesthetic. No cases of clinically symptomatic pneumothorax developed. Complications included symptomatic hemidiaphragmatic paresis (1%), Horner syndrome (1%), unintended vascular punctures (0.4%), and transient sensory deficits (0.4%).
  
  
  CONCLUSIONS
  Ultrasound-guided supraclavicular block is associated with a high rate of successful surgical anesthesia and a low rate of complications and thus may be a safe alternative for both inpatients and outpatients. Severe underlying respiratory disease and coagulopathy should remain a contraindication for this brachial plexus approach.
authors.affiliation: Department of Anesthesia, University of Toronto, Ontario, Canada. Anahi.perlas@uhn.on.ca
authors.forename: Anahi
authors.initials: A
authors.lastname: Perlas
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lobo
authors.forename: Nick
authors.initials: N
authors.lastname: Lo
authors.forename: Richard
authors.initials: R
authors.lastname: Brull
authors.forename: Vincent W S
authors.initials: VW
authors.lastname: Chan
authors.forename: Reena
authors.initials: R
authors.lastname: Karkhanis
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage; D001132:Arm / Q000294:innervation / Q000601:surgery; D001917:Brachial Plexus / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000779:Anesthetics, Local