title: Axillary approach versus the infraclavicular approach in ultrasound-guided brachial plexus block: comparison of anesthetic time.
abstract: BACKGROUND
  With ultrasound guidance, the success rate of brachial plexus block (BPB) is 95-100% and the anesthetic time has become a more important factor than before. Many investigators have compared ultrasound guidance with the nerve stimulation technique, but there are few studies comparing different approaches via the same ultrasound guidance. We compared the axillary BPB with the infraclavicular BPB under ultrasound guidance.
  
  
  METHODS
  Twenty-two ASA physical status I-II patients presenting with elective forearm surgery were prospectively randomized to receive an axillary BPB (group AX) or an infraclavicular BPB (group IC) with ultrasound guidance. Both groups received a total of 20 ml of 1.5% lidocaine with 5 µg/ml epinephrine and 0.1 mEq/ml sodium bicarbonate. Patients were then evaluated for block onset and block performance time was also recorded.
  
  
  RESULTS
  Group IC demonstrated a reduction in performance time vs. group AX (622 ± 139 sec vs. 789 ± 131 sec, P < 0.05). But, the onset time was longer in group IC than in group AX (7.7 ± 8.8 min vs. 1.4 ± 2.3 min, P < 0.05). All blocks were successful in both groups.
  
  
  CONCLUSIONS
  Under ultrasound guidance, infraclavicular BPB was faster to perform than the axillary approach. But the block onset was slower with the infraclavicular approach.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea.
authors.forename: In Ae
authors.initials: IA
authors.lastname: Song
authors.forename: Nam-Su
authors.initials: NS
authors.lastname: Gil
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Choi
authors.forename: Sung-Eun
authors.initials: SE
authors.lastname: Sim
authors.forename: Seong-Won
authors.initials: SW
authors.lastname: Min
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Ro
authors.forename: Chong Soo
authors.initials: CS
authors.lastname: Kim