Abstract
For an UltraSound guided Infraclavicular Block, a non-inferiority randomized study was conducted comparing two volumes of ropivacaine 0.75%: 35 ml vs 30ml. Fifty 18-70 years old patients undergoing upper limb surgery, ASA I-II were enrolled. Exclusion criteria included existing neurologic disease, coagulopathy, allergy, pregnancy, previous surgery in clavicular region, BMI more than 30 kg/m2 or patients unable to give written consent. Using US guidance, a 22 gauge/80 mm SonoPlex needle (Pajunk®) was advanced until the tip was located dorsally to the artery at a 6-o’clock position. Correct placement was ensuring by a “double bubble” sign. The block was performed by delivering ropivacaine 0.75% via an infusion pump (Alaris® PK) at 600 ml/h.
Highlights
The UltraSound-Guided (USG) InfraClavicular Block (ICB) offers several advantages over the axillary block of brachial plexus: the single injection [1], needed in the first approach, causes less discomfort [1,2,3,4] and fewer adverse events than the multiple injections required in the latter for a comparable block success
In our clinical experience we observed that even lower doses can be successful and, for a USG-ICB, we considered the suggested volume used by Tran et al as a comparative standard dose for a non-inferiority study, using ropivacaine 0.75% in two volumes: the first of 35ml, equal to the one used by Tran et al for lidocaine 1.5%, and the second, just less than the previous, of 30ml
The Block Success (BS) and the Block Failure (BF) rate was respectively 22/25 (88%) and 3/25 (12%) (p=NS) regardless of the group of origin (G30 or G35); we rejected the hypothesis of higher efficiency with a volume of 35ml instead of 30ml
Summary
The UltraSound-Guided (USG) InfraClavicular Block (ICB) offers several advantages over the axillary block of brachial plexus: the single injection [1], needed in the first approach, causes less discomfort [1,2,3,4] and fewer adverse events than the multiple injections required in the latter for a comparable block success. The ICB secures a pronounced sensory and motor blockade of the musculocutaneous nerve and of an additional spectrum of nerves such as the thoracodorsal, the axillary and the medial brachial cutaneous nerves. This wide blockade extension reduces the likelihood of tourniquet pain during surgery compared to the axillary approach of the Brachial Plexus Block (BPB) [5,6]. The single-injection of anesthetics with the “double bubble” technique [9] assures a high success blockade rate [10]
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