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Double- vs. single-injection infraclavicular plexus block in the emergency setting: higher success rate with lower volume of local anaesthetic

  • R. Fuzier (a1), O. Fourcade (a1), V. Fuzier (a1), N. Albert (a2), K. Samii (a1) and M. Olivier (a1)...



Background and objectives: Infraclavicular plexus block has many advantages of particular interest in the emergency setting. However, the number of nerve stimulations needed to optimize the technique remains unclear. We evaluated both the local anaesthetic requirement and the success rate of Sim's derived infraclavicular plexus block performed with a nerve stimulator when either one or two responses were sought. Methods: In this prospective study, 50 patients who presented for distal upper limb surgery were randomized into two groups: in Group 1, ropivacaine 0.75% 40 mL was injected when nerve stimulation elicited a distal motor response (median, ulnar or radial). In Group 2, only 30 mL of the same local anaesthetic was injected, 7 mL to the musculocutaneous nerve and 23 mL to the median, ulnar or radial nerves. Sensory and motor blocks were tested at 5-min intervals over 30 min. Results: The time to perform the block was similar in both groups. The success rate of the block increased from 80% in the single-stimulation group to 92% in the double-stimulation group (not significant). The onset time of sensory and motor block was shorter and block extension was greater in ulnar, antebrachial cutaneous and brachial cutaneous nerve distributions in the multistimulation group (P < 0.05). Conclusions: We conclude that only 30 mL of local anaesthetic seems to be sufficient to ensure a high level of success when performing an infraclavicular block with stimulation of both the musculocutaneous nerve and median, ulnar or radial nerve.


Corresponding author

Correspondence to: Régis Fuzier, Anesthésiste, Service Orthopédie, CHU Purpan, Place Dr Baylac, TSA 40031, F-31059 Toulouse Cedex 9, France. E-mail:; Tel: +33 561 777 443; Fax: +33 561 777 746


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Fuzier R, Tissot B, Mercier-Fuzier V et al. Evaluation of regional anesthesia procedure in an emergency department. Ann Fr Anesth Reanim 2002; 21: 193197.
Wilson JL, Brown DL, Wong GY, Ehman RL, Cahill DR. Infraclavicular brachial plexus block: parasagittal anatomy important to the coracoid technique. Anesth Analg 1998; 87: 870873.
Fuzier R, Fuzier V, Albert N, Decramer I, Samii K, Olivier M. The infraclavicular block is a useful technique for emergency upper extremity analgesia. Can J Anaesth 2004; 51: 191192.
Deleuze A, Gentili ME, Marret E, Lamonerie L, Bonnet F. A comparison of a single-stimulation lateral infraclavicular plexus block with a triple-stimulation axillary block. Reg Anesth Pain Med 2003; 28: 8994.
Gaertner E, Estebe JP, Zamfir A, Cuby C, Macaire P. Infraclavicular plexus block: multiple injection versus single injection. Reg Anesth Pain Med 2002; 27: 590594.
Rodriguez J, Barcena M, Taboada-Muniz M, Lagunilla J, Alvarez J. A comparison of single versus multiple injections on the extent of anesthesia with coracoid infraclavicular brachial plexus block. Anesth Analg 2004; 99: 12251230.
Minville V, N'Guyen L, Chassery C et al. A modified coracoid approach to infraclavicular brachial plexus blocks using a double-stimulation technique in 300 patients. Anesth Analg 2005; 100: 263265.
Rodriguez J, Barcena M, Rodriguez V, Aneiros F, Alvarez J. Infraclavicular brachial plexus block effects on respiratory function and extent of the block. Reg Anesth Pain Med 1998; 23: 564568.
Ilfeld BM, Morey TE, Enneking FK. Continuous infraclavicular brachial plexus block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesthesiology 2002; 96: 12971304.
Maurer K, Ekatodramis G, Rentsch K, Borgeat A. Interscalene and infraclavicular block for bilateral distal radius fracture. Anesth Analg 2002; 94: 450452.
Kapral S, Jandrasits O, Schabernig C et al. Lateral infraclavicular plexus block vs. axillary block for hand and forearm surgery. Acta Anaesthesiol Scand 1999; 43: 10471052.
Fitzgibbon DR, Debs AD, Erjavec MK. Selective musculocutaneous nerve block and infraclavicular brachial plexus anesthesia. Case report. Reg Anesth 1995; 20: 239241.
Borgeat A, Ekatodramis G, Dumont C. An evaluation of the infraclavicular block via a modified approach of the Raj technique. Anesth Analg 2001; 93: 436441.
Whiffler K. Coracoid block – a safe and easy technique. Br J Anaesth 1981; 53: 845848.
Koscielniak-Nielsen ZJ, Nielsen PR, Mortensen CR. A comparison of coracoid and axillary approaches to the brachial plexus. Acta Anaesthesiol Scand 2000; 44: 274279.
Desroches J. The infraclavicular brachial plexus block by the coracoid approach is clinically effective: an observational study of 150 patients. Can J Anaesth 2003; 50: 253257.


Double- vs. single-injection infraclavicular plexus block in the emergency setting: higher success rate with lower volume of local anaesthetic

  • R. Fuzier (a1), O. Fourcade (a1), V. Fuzier (a1), N. Albert (a2), K. Samii (a1) and M. Olivier (a1)...


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