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Speed of onset of ‘corner pocket supraclavicular’ and infraclavicular ultrasound guided brachial plexus block: a randomised observer‐blinded comparison
Author(s) -
Fredrickson M. J.,
Patel A.,
Young S.,
Chinchanwala S.
Publication year - 2009
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2009.05918.x
Subject(s) - medicine , brachial plexus , supraclavicular fossa , subclavian artery , anesthesia , lidocaine , brachial plexus block , axillary artery , surgery , brachial artery , ultrasound , radiology , cancer , breast cancer , blood pressure
Summary This prospective, randomised, observer blinded study compared the onset time of brachial plexus block using 2% lidocaine 25–30 ml with adrenaline 5 μg.ml −1 into the ‘corner pocket’ inferolateral/lateral to the subclavian artery (supraclavicular, n = 30) or to a triple point injection around the axillary artery (infraclavicular, n = 30). Mean (SD) onset time for complete pinprick sensory blockade assessed by a blinded observer in all four distal nerves was similar in both groups: supraclavicular = 22 (9.4) min, infraclavicular = 21 (7.1) min, p = 0.59. Complete sensory blockade in all four nerve territories at 30 min was achieved in 57% in group supraclavicular and 70% in group infraclavicular (p = 0.28). Painless surgery without the requirement for block supplementation was higher in group infraclavicular (28/30, 93%) compared with group supraclavicular (19/30, 67%; p = 0.01). Of the 11 failures in group supraclavicular, nine were due to incomplete ulnar nerve territory anaesthesia. These results do not support the concept of rapid onset successful supraclavicular block via a simple ultrasound‐guided local anaesthetic injection inferolateral to the subclavian artery.