Abstract
Purpose
To evaluate the sensory distribution, motor block and the clinical efficacy of the infraclavicular block by the coracoid approach.
Methods
In this prospective descriptive study ISO patients received an infraclavicular block by the coracoid approach performed by a single anesthesiologist. Neurostimulation was used and 40 mL of mepivacaine 1.5% with adrenaline were injected. Block performance time, sensory distribution, motor block and tourniquet tolerance were evaluated.
Results
Time to perform the block was S ± 2 min (mean ± SD). Success rate defined as analgesia in the five nerves distal to the elbow (musculocutaneous, median, ulnar, radial and medial cutaneous nerve of the forearm) was 91% (137 patients). A proximal block of the axillary nerve was present in 98.5% of the patients and of the medial cutaneous nerve of the arm in 60%. An arm tourniquet ( 250 mmHg of pressure ) was applied to 115 of the 137 patients with a successful block and all tolerated the tourniquet for a duration of 37 ± 21 min ( mean ± SD).
Conclusion
Infraclavicular block by the coracoid approach provides an extensive sensory distribution with an excellent tourniquet tolerance. We conclude that this approach provides highly consistent brachial plexus anesthesia for upper extremity surgery.
Résumé
Objectif
Évaluer la distribution du bloc sensitif, le bloc moteur et l’efficacité clinique du bloc infraclaviculaire par l’approche coracoïde.
Méthode
Dans cette étude prospective et descriptive, un bloc infraclaviculaire a été réalisé selon l’approche coracoïde par un même anesthésiologiste chez 150 patients. La neurostimulation a été utilisée et 40 mL de mépivacaïne à 1,5 % avec adrénaline ont été injectés. Le temps pour réaliser le bloc, la distribution sensitive, le degré de bloc moteur et la tolérance au garrot ont été évalués.
Résultats
Le temps pour réaliser le bloc a été de 5 ± 2 min (moyenne ± écart type). L’efficacité définie par l’analgésie dans les cinq nerfs distaux au coude (musculocutané, médian, cubital, radial et le nerf brachial cutané interne) a été de 91 % (137 patients). Une extension proximale du bloc au nerf circonflexe était présente chez 98,5 % des patients et au nerf accessoire du brachial cutané interne chez 60 %. Un garrot (pression de 250 mmHg) a été utilisé chez 115 des 137 patients avec un bloc efficace et tous ont toléré le garrot pour une durée de 37 ± 21 min (moyenne ± écart type).
Conclusion
Le bloc infraclaviculaire réalisé selon l’approche coracoïde produit un bloc sensitif étendu avec une excellente tolérance du garrot. Cette approche produit donc de façon hautement prévisible une anesthésie du plexus brachial permettant la chirurgie du membre supérieur.
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Desroches, J. The infraclavicular brachial plexus block by the coracoid approach is clinically effective: an observational study of 150 patients. Can J Anaesth 50, 253–257 (2003). https://doi.org/10.1007/BF03017794
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DOI: https://doi.org/10.1007/BF03017794