title: Single vs. double stimulation during a lateral sagittal infraclavicular block.
abstract: BACKGROUND
  The objective of this study was to evaluate the influence of single vs. dual control during an ultrasound-guided lateral sagittal infraclavicular block on the efficacy of sensory block and the time of block onset.
  
  
  METHODS
  In a prospective manner, 60 adult patients scheduled for distal upper limb surgery were randomly allocated to single (Group S) or double stimulation (Group D) groups. A local anesthetic (LA) mixture of 20 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml with 5 microg/ml epinephrine (total 40 ml) was administered in both groups. In the Group S following a median, an ulnar or a radial nerve response, the entire LA was administered at a single site. In Group D 10 ml of LA was administered following the electrolocation of the musculocutaneous nerve and 30 ml LA was injected following median, ulnar or radial nerves. A successful block was defined as analgesia or anesthesia of all five nerves distal to the elbow. Sensory and motor blocks were tested at 5-min intervals for 30 min.
  
  
  RESULTS
  The block was successful in 27 patients in Group S and 28 patients in Group D. The time from starting the block until satisfactory anesthesia was significantly shorter in Group D than in Group S (19.3 vs. 23.2 min) (P<0.05). Total sensory scores were significantly higher in the double stimulation group at 20 and 30 min after the block performance (P<0.05).
  
  
  CONCLUSIONS
  Although the block performance time was longer in the double stimulation group, block onset time and extent of anesthesia were more favorable in the double stimulation group.
authors.affiliation: School of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Akyildiz
authors.forename: Y
authors.initials: Y
authors.lastname: Gürkan
authors.forename: C
authors.initials: C
authors.lastname: Cağlayan
authors.forename: M
authors.initials: M
authors.lastname: Solak
authors.forename: K
authors.initials: K
authors.lastname: Toker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D000077554:Levobupivacaine; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008475:Median Nerve; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects*; D009407:Nerve Block / Q000379:methods*; D011446:Prospective Studies; D011826:Radial Nerve; D012677:Sensation / Q000187:drug effects*; D016896:Treatment Outcome; D014459:Ulnar Nerve; D018084:Ultrasonography, Interventional; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D000077554:Levobupivacaine; D002045:Bupivacaine; D004837:Epinephrine