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Double- vs. single-injection infraclavicular plexus block in the emergency setting: higher success rate with lower volume of local anaesthetic

Published online by Cambridge University Press:  22 February 2006

R. Fuzier ,
O. Fourcade ,
V. Fuzier ,
N. Albert ,
K. Samii  and
M. Olivier
R. Fuzier
Affiliation:
University Hospital Center, Purpan Hospital, Department of Anesthesiology, Toulouse Cedex, France
O. Fourcade
Affiliation:
University Hospital Center, Purpan Hospital, Department of Anesthesiology, Toulouse Cedex, France
V. Fuzier
Affiliation:
University Hospital Center, Purpan Hospital, Department of Anesthesiology, Toulouse Cedex, France
N. Albert
Affiliation:
University Hospital Center of Laval, Department of Anaesthesiology, Sainte Foy, Quebec, Canada
K. Samii
Affiliation:
University Hospital Center, Purpan Hospital, Department of Anesthesiology, Toulouse Cedex, France
M. Olivier
Affiliation:
University Hospital Center, Purpan Hospital, Department of Anesthesiology, Toulouse Cedex, France
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Summary

Background and objectives: Infraclavicular plexus block has many advantages of particular interest in the emergency setting. However, the number of nerve stimulations needed to optimize the technique remains unclear. We evaluated both the local anaesthetic requirement and the success rate of Sim's derived infraclavicular plexus block performed with a nerve stimulator when either one or two responses were sought. Methods: In this prospective study, 50 patients who presented for distal upper limb surgery were randomized into two groups: in Group 1, ropivacaine 0.75% 40 mL was injected when nerve stimulation elicited a distal motor response (median, ulnar or radial). In Group 2, only 30 mL of the same local anaesthetic was injected, 7 mL to the musculocutaneous nerve and 23 mL to the median, ulnar or radial nerves. Sensory and motor blocks were tested at 5-min intervals over 30 min. Results: The time to perform the block was similar in both groups. The success rate of the block increased from 80% in the single-stimulation group to 92% in the double-stimulation group (not significant). The onset time of sensory and motor block was shorter and block extension was greater in ulnar, antebrachial cutaneous and brachial cutaneous nerve distributions in the multistimulation group (P < 0.05). Conclusions: We conclude that only 30 mL of local anaesthetic seems to be sufficient to ensure a high level of success when performing an infraclavicular block with stimulation of both the musculocutaneous nerve and median, ulnar or radial nerve.

Keywords

REGIONAL ANAESTHESIA, brachial plexus block, infraclavicular blockANAESTHETICS LOCAL, ropivacaineEMERGENCY MEDICINE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 4 , April 2006 , pp. 271 - 275
Copyright
© 2006 European Society of Anaesthesiology

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