Lateral sagittal infraclavicular block: clinical experience in 380 patients

Abstract

The purpose of this study was to evaluate the clinical utility and block success rate of 'lateral sagittal infraclavicular block (LSIB)' in a large-scale clinical study. Adult patients scheduled for hand, wrist and forearm surgery between March 2005 and June 2007 were prospectively included into the study. Using a nerve stimulator LSIB was performed. In the LSIB technique the puncture site is immediately adjacent to the most medial point of the coracoid process and the anterior surface of the clavicula. The needle is inserted caudally in a sagittal plane, 20 degrees dorsally (downwards), until muscle twitches are observed in synchrony with the stimulation. A Local anesthetic mixture of either 20 ml bupivacaine 5 mg/ml or 20 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml with 5 microg/ml epinephrine (total volume 40 ml) was administered following electrolocation of the median, radial or ulnar nerve. Three-hundred and eighty patients were included into the study. Block was successful in 341 (89.7%) patients without any need for local anesthetic supplementation. We had complete failure in 17 (4.5%) patients and these patients received general anesthesia. Twenty-two (5.8%) patients needed either infiltration of local anesthetic at the site of skin incision or supplementation of the block at the axilla. No other complications other than vascular punctures - 25 patients (6.6%) - were observed. LSIB provided a clinically acceptable success rate and our results are in agreement with other studies assessing this approach.