Ultrasound-guided continuous infraclavicular block for hand surgery: Technical report arm position for perineural catheter placement1

BackgroundContinuous perineural infusion of local anaesthetic 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 the brachial plexus more superficial and which elevates the clavicle in the cephalic direction.ObjectiveThe aim of this study was to identify whether the abduction of the arm decreases the skin-plexus distance, making the perineural insertion of the catheter easier and for a better analgesia. This relationship between the arm and the insertion of catheter has not yet been established.Material and methodsThe study included 58 adult patients, undergoing forearm and hand surgery, initially divided into two groups, adduction and abduction. Ultrasound-guided infraclavicular block was performed, enabling the catheter tip to be positioned adjacent to the posterior cord. The group of patients with high technical difficulties were allowed to reposition the arm abduction. A record was made of the number of punctures, redirects, ease of insertion of the catheter, and skin-plexus distance.ResultsThe abduction of the arm moved the clavicle towards the cephalad and separated it from the linear transducer, this allowed to manoeuvre the needle right angle and redirect it. The skin-plexus distance did not decrease significantly with arm position.ConclusionsArm abduction allows better scanning, facilitates the infraclavicular puncture, and catheter introduction