title: [Ultrasound-guided continuous infraclavicular block for hand surgery: technical report arm position for perineural catheter placement].
abstract: BACKGROUND
  Continuous perineural infusion of local anesthetic provides better postoperative analgesia than intravenous administration of opioids or NSAIDs in upper limb surgery. The infraclavicular approach is a good option due to the muscular stability to catheter; the abduction of the arm apparently makes more superficial the brachial plexus and which elevates clavicle cephalad.
  
  
  OBJECTIVE
  The aim of this study was to identify whether the abduction of the arm for to decreases the skin-plexus distance, facilitating it catheter insertion in a perineural way for a better analgesia. This relation between the arm and the colocation of catheter has not yet been established.
  
  
  METHODS
  We included 58 adult patients, undergoing forearm and hand surgery, initially divided into two groups, adduction and abduction. It was placed continuous infraclavicular block guided by ultrasound, it allow the catheter tip was adjacent to the posterior cord. In the group patients with high technical difficulties were allowed to reposition the arm abduction, recording number of punctures, redirects, ease of insertion of the catheter and skin-plexus distance.
  
  
  RESULTS
  The abduction of the arm moved the clavicle toward cephalad and separated it from the linear transducer, this allowed to maneuver the needle right angle and redirect it, the distance skin-plexus did not decrease significantly with arm position.
  
  
  CONCLUSIONS
  Arm abduction allows better scanning facilitates the infraclavicular puncture and catheter introduction.
authors.affiliation: Servicio de Anestesiología, Instituto Nacional de Rehabilitación, México DF, México. Electronic address: zararegional@hotmail.com.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Zaragoza-Lemus
authors.affiliation: Servicio de Anestesiología, Instituto Nacional de Rehabilitación, México DF, México.
authors.forename: Verónica
authors.initials: V
authors.lastname: Hernández-Gasca
authors.affiliation: Servicio de Cirugía de Mano y Microcirugía, Instituto Nacional de Rehabilitación, México DF, México.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Espinosa-Gutiérrez
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D000886:Anthropometry; D001366:Axillary Artery / Q000293:injuries; D001917:Brachial Plexus / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D002968:Clavicle / Q000033:anatomy & histology; D005260:Female; D005542:Forearm / Q000601:surgery*; D006225:Hand / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000295:instrumentation / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D010292:Paresthesia / Q000209:etiology; D056888:Patient Positioning; D011183:Postoperative Complications / Q000209:etiology; D011677:Punctures; D012867:Skin / Q000033:anatomy & histology; D018084:Ultrasonography, Interventional; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local
keywords: Bloqueo infraclavicular; Catheter; Catéter; Cirugía de mano; Hand surgery; Infraclavicular block; Ultrasonido; Ultrasound