Comparing vertical and coracoid approaches for infraclavicular block in orthopedic surgery of the forearm and hand

Abstract

Study Objective: To determine if there is a difference between the vertical and coracoid approaches to the infraclavicular block. Design: Randomized, double-blinded clinical trial. Setting: University-affiliated medical center. Patients: 60 ASA physical status 1 and 2 patients undergoing surgery of the forearm and hand. Interventions: Patients were randomized to two groups: Group VIP (vertical infraclavicular approach; n=30) and Group Coracoid (coracoid infraclavicular approach; n=30). In the infraclavicular coracoid approach, the coracoid process was used as the landmark. Needle positioning was guided by nerve stimulation. Measurement: For each approach, the quality of sensory and motor block was assessed and recorded separately for each of the 4 major nerves of the upper limb. Main Results: The infraclavicular coracoid approach (11±1 min) was faster to perform than the vertical infraclavicular block (14±1 min; P < 0.05). The infraclavicular coracoid approach yielded a shorter sensory block onset time (2.3±1.3 vs 3±1.3 min; P < 0.05). In the coracoid group, a pronounced sensory and motor block was noted in the area innervated by the musculocutaneous nerve (P < 0.05). Conclusion: The coracoid approach is convenient to perform with extensive block, and is thus an appropriate alternative to the vertical approach in infraclavicular block. © 2012 Elsevier Inc.