Infraclavicular catheter placement

Abstract

We wish to congratulate Dhir et al. for making some interesting observations in their comparison between ultrasound and nerve stimulation for infraclavicular catheter placement 1. We would like to ask the authors about two particular aspects of their study. Firstly, why were patients with a body mass index greater than 35 kg.m−2 excluded from the study? Our clinical practice suggests that such patients present for surgery increasingly commonly. Statistics for England in 2014 support this observation: 5% adults had a body mass index (BMI) between 35.0 and 39.9 kg.m−2, and 2% had a BMI > 40 kg.m−2 2. As with any other regional anaesthetic technique, BMI increases the technical difficulties of the procedure. However, this group of patients might be expected to benefit greatly from the anaesthesia and analgesia provided by infraclavicular catheter placement, by avoiding general anaesthesia, taking less opioids and staying in hospital for a shorter period. Secondly, did the authors consider including a third group of study participants, to receive infraclavicular catheter placement using a dual approach (ultrasound and nerve stimulation guidance)? Do they think that procedure time and overall complication rates would have been lower in this group in comparison with the sole nerve-stimulation or sole ultrasound-guided groups described in their study?