title: Selective local anesthetic placement using ultrasound guidance and neurostimulation for infraclavicular brachial plexus block.
abstract: BACKGROUND
  In this study, we performed the infraclavicular block with combined ultrasound guidance and neurostimulation to selectively target cords to compare the success rates of placing a single injection of local anesthetic either in a central or peripheral location.
  
  
  METHODS
  Two hundred eighteen patients were enrolled in a consecutive, prospective study. Patients were randomized to injection of local anesthetic either centrally (posterior cord) or peripherally (medial or lateral cord) using ultrasound guidance and neurostimulation. Supervised senior anesthesiology residents or attending anesthesiologists performed the blocks. Both intent-to-treat and treatment-received analyses were used to compare central and peripheral placement efficacy.
  
  
  RESULTS
  The overall success rate was significantly higher for the central placements than peripheral placements (96% vs 85%, P = 0.004). Individual cord success rates were as follows: posterior 99%, lateral 92%, and medial 84% (P = 0.001). The central group required attending physician intervention more frequently (27% vs 6%, P < 0.001). Postoperative pain scores of < or =3 were more likely with central placement (100% vs 94%, P = 0.012).
  
  
  CONCLUSIONS
  Central placement of a single injection of local anesthetic targeted at the posterior cord resulted in a higher success rate for infraclavicular block.
authors.affiliation: Department of Anesthesiology, Vanderbilt Medical Center, Nashville, TN 37232-5614, USA. clifford.bowens@vanderbilt.edu
authors.forename: Clifford
authors.initials: C
authors.lastname: Bowens
authors.forename: Rajnish K
authors.initials: RK
authors.lastname: Gupta
authors.forename: William T
authors.initials: WT
authors.lastname: O'Byrne
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Schildcrout
authors.forename: Yaping
authors.initials: Y
authors.lastname: Shi
authors.forename: Jermel J
authors.initials: JJ
authors.lastname: Hawkins
authors.forename: Damon R
authors.initials: DR
authors.lastname: Michaels
authors.forename: James M
authors.initials: JM
authors.lastname: Berry
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001917:Brachial Plexus / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009068:Movement / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D009407:Nerve Block / Q000379:methods*; D019637:Orthopedic Procedures; D010149:Postoperative Pain / Q000453:epidemiology; D011446:Prospective Studies; D012677:Sensation / Q000502:physiology; D016683:Supine Position; D016896:Treatment Outcome; D014463:Ultrasonography; D034941:Upper Extremity / Q000601:surgery; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local