A comparison of infraclavicular and supraclavicular approaches to the brachial plexus using neurostimulation.
BACKGROUND
A prospective, double blind study was performed to compare the clinical effect of vertical infraclavicular and supraclavicular brachial plexus block using a nerve stimulator for upper limb surgery.


METHODS
One hundred patients receiving upper limb surgery under infraclavicular or supraclavicular brachial plexus block were enrolled in this study. The infraclavicular brachial plexus block was performed using the vertical technique with 30 ml of 0.5% ropivacaine. The supraclavicular brachial plexus block was performed using the plumb bob technique with 30 ml of 0.5% ropivacaine. The block performance-related pain was evaluated. This study observed which nerve type was stimulated, and scored the sensory and motor block. The quality of the block was assessed intra-operatively. The duration of the sensory and motor block as well as the complications were assessed. The patient's satisfaction with the anesthetic technique was assessed after surgery.


RESULTS
There were no significant differences in the block performance-related pain, frequency of the stimulated nerve type, evolution of sensory and motor block quality, or the success of the block. There were no significant differences in the duration of the sensory and motor block. There was a significant difference in the incidence of Horner's syndrome. Two patients had a pneumothorax in the supraclavicular approach. There were no significant differences in the patient's satisfaction.


CONCLUSIONS
Both infraclavicular and supraclavicular brachial plexus block had similar effects. The infraclavicular approach may be preferred to the supraclavicular approach when considering the complications.
Yang
Chun Woo
CW
Department of Anesthesiology and Pain Medicine, College of Medicine, Konyang University, Daejeon, Korea.
Kwon
Hee Uk
HU
Cho
Choon-Kyu
CK
Jung
Sung Mee
SM
Kang
Po-Soon
PS
Park
Eun-Su
ES
Heo
Youn Moo
YM
Shinn
Helen Ki
HK