Lateral infraclavicular plexus block vs. axillary block for hand and forearm surgery

Background: In the last few years infraclavicular plexus block has become a method of increasing interest. However, this block has been associated wit h high complication incidences and without advantage in the quality of bloc kade over the axillary approach. We prospectively studied 40 patients (ASA I-III) undergoing surgery of the forearm and hand, and investigated the per formance of the lateral infraclavicular plexus block against an axillary pa ravascular block to evaluate the success rate as well as the extent and qua lity of blockade. Methods: Patients were randomized into two groups: group I (lateral infracl avicular approach; n = 20) and group A (axillary approach; n = 20). The lat eral infraclavicular approach is a technique with the coracoid process (CP) as landmark. Alone the sagittal plane, the needle is inserted until contac t with the CP. The needle is then withdrawn 2-3 mm and reinserted directly under the Cr, until it contacts the brachial plexus sheath. Plexus blockade was performed using 40 ml of mepivacaine 1%. Quality of sensory and motor block was recorded selectively for each nerve distribution at close interva ls for 6 h. Results: Successful block according to Vester-Andersen's criteria was achie ved in 100% of group I and 85% of group A. In group I, a pronounced sensory and motor blockade of the musculocutaneous nerve was observed, while patie nts of group A had a weak block of this nerve. In group I, an additional sp ectrum of nerves (thoracodorsal, axillary and medial brachial cutaneous ner ves) was involved compared to group A. There was no difference among groups in onset and duration of block. Conclusion: Based on the safe landmark and feasibility of this procedure an d the additional spectrum of nerve block achieved, the application of later al infraclavicular technique has to be reconsidered in clinical practice.