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The infraclavicular brachial plexus block by the coracoid approach is clinically effective: an observational study of 150 patients

[Le bloc infraclaviculaire du plexus brachial, réalisé par l’approche coracoïde, est efficace sur le plan clinique : une étude prospective de 150 patients]

From the Department of Anesthesia, Hôtel-Dieu de Saint-Jérôme, Saint-Jérôme, Québec, Canada.

Address correspondence to: Dr. Jean Desroches, Department of Anesthesia, Hôtel-Dieu de Saint-Jérôme, 290 rue Montigny, Saint-Jérôme, Québec J7Z 5T3, Canada. Phone: 450-431-8200; Fax: 450-431-8208; E-mail: jean.desroches{at}sympatico.ca

Purpose: To evaluate the sensory distribution, motor block and the clinical efficacy of the infraclavicular block by the coracoid approach.

Methods: In this prospective descriptive study, 150 patients received an infraclavicular block by the coracoid approach performed by a single anesthesiologist. Neurostimulation was used and 40 mL of mepivacaine 1.5% with adrenaline were injected. Block performance time, sensory distribution, motor block and tourniquet tolerance were evaluated.

Results: Time to perform the block was 5 ± 2 min (mean ± SD). Success rate defined as analgesia in the five nerves distal to the elbow (musculocutaneous, median, ulnar, radial and medial cutaneous nerve of the forearm) was 91% (137 patients). A proximal block of the axillary nerve was present in 98.5% of the patients and of the medial cutaneous nerve of the arm in 60%. An arm tourniquet ( 250 mmHg of pressure ) was applied to 115 of the 137 patients with a successful block and all tolerated the tourniquet for a duration of 37 ± 21 min ( mean ± SD).

Conclusion: Infraclavicular block by the coracoid approach provides an extensive sensory distribution with an excellent tourniquet tolerance. We conclude that this approach provides highly consistent brachial plexus anesthesia for upper extremity surgery.

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