Ultrasound-guided infraclavicular brachial plexus block

• Published in: British journal of anaesthesia : BJA Vol. 89; no. 2; pp. 254 - 259
• Main Authors: Sandhu, N.S., Capan, L.M.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.08.2002; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Adolescent; Adult; Aged; anaesthesia regional; anaesthesia regional, brachial plexus; anaesthetics local; anaesthetics local, lidocaine; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - administration & dosage; Biological and medical sciences; Brachial Plexus; Feasibility Studies; Female; Humans; lidocaine; Lidocaine - administration & dosage; Local anesthesia. Pain (treatment); Male; measurement techniques; measurement techniques, ultrasound; Medical sciences; Middle Aged; Nerve Block - methods; pectoral; surgery; surgery, pectoral; Ultrasonography, Interventional - methods; ultrasound; surgery, pectoral; anaesthetics local, lidocaine; anaesthesia regional, brachial plexus; measurement techniques, ultrasound; anaesthesia regional, brachial plexus; anaesthetics local, lidocaine; measurement techniques, ultrasound; surgery, pectoral; Local anesthetic; Sonography; Guidance; Human; Regional anesthesia; Brachial plexus; Blocking; Surgical approach; Organic amide; Technique; Lidocaine
• DOI: 10.1093/bja/aef186
• ISSN: 0007-0912

Peripheral nerve blocks are almost always performed as blind procedures. The purpose of this study was to test the feasibility of seeing individual nerves of the brachial plexus and directing the block needle to these nerves with real time imaging. Using ultrasound guidance, infraclavicular brachial plexus block was performed in 126 patients. Important aspects of this standardized technique included (i) imaging the axillary artery and the three cords of the brachial plexus posterior to the pectoralis minor muscle, (ii) marking the position of the ultrasound probe before introducing a Tuohy needle, (iii) maintaining the image of the entire length of the needle at all times during its advancement, (iv) depositing local anaesthetic around each of the three cords and (v) placing a catheter anterior to the posterior cord when indicated. In 114 (90.4%) patients, an excellent block permitted surgery without a need for any supplemental anaesthetic or conversion to general anaesthesia. In nine (7.2%) patients local or perineural administration of local anaesthetic, and in three (2.4%) conversion to general anaesthesia, was required. Mean times to administer the block, onset of block and complete block were 10.0 (sd 4.4), 3.0 (1.3) and 6.7 (3.2) min, respectively. Mean lidocaine dose was 695 (107) mg. In one patient, vascular puncture occurred. In 53 (42.6%) patients, an indwelling catheter was placed, but only three required repeat injections, which successfully prolonged the block. The use of ultrasound appears to permit accurate deposition of the local anaesthetic perineurally, and has the potential to improve the success and decrease the complications of infraclavicular brachial plexus block.