title: Comparing vertical and coracoid approaches for infraclavicular block in orthopedic surgery of the forearm and hand.
abstract: OBJECTIVE
  To determine if there is a difference between the vertical and coracoid approaches to the infraclavicular block.
  
  
  METHODS
  Randomized, double-blinded clinical trial.
  
  
  METHODS
  University-affiliated medical center.
  
  
  METHODS
  60 ASA physical status 1 and 2 patients undergoing surgery of the forearm and hand.
  
  
  METHODS
  Patients were randomized to two groups: Group VIP (vertical infraclavicular approach; n=30) and Group Coracoid (coracoid infraclavicular approach; n=30). In the infraclavicular coracoid approach, the coracoid process was used as the landmark. Needle positioning was guided by nerve stimulation.
  
  
  METHODS
  For each approach, the quality of sensory and motor block was assessed and recorded separately for each of the 4 major nerves of the upper limb.
  
  
  RESULTS
  The infraclavicular coracoid approach (11±1 min) was faster to perform than the vertical infraclavicular block (14±1 min; P < 0.05). The infraclavicular coracoid approach yielded a shorter sensory block onset time (2.3±1.3 vs 3±1.3 min; P < 0.05). In the coracoid group, a pronounced sensory and motor block was noted in the area innervated by the musculocutaneous nerve (P < 0.05).
  
  
  CONCLUSIONS
  The coracoid approach is convenient to perform with extensive block, and is thus an appropriate alternative to the vertical approach in infraclavicular block.
authors.affiliation: Department of Anesthesiology, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Framarz
authors.initials: F
authors.lastname: Mosaffa
authors.forename: Babak
authors.initials: B
authors.lastname: Gharaei
authors.forename: Mehran
authors.initials: M
authors.lastname: Rafeeyan
authors.forename: Latif
authors.initials: L
authors.lastname: Gachkar
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002968:Clavicle; D004311:Double-Blind Method; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D005542:Forearm / Q000601:surgery*; D006225:Hand / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods*; D016037:Single-Blind Method; D055815:Young Adult