Infraclavicular plexus block: Multiple injection versus single injection

Abstract

We conclude that by performing an infraclavicular block with stimulation of all 3 cords of the brachial plexus, the success rate is higher than when only a single stimulation is used.

Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks

“…Secondly, because failed and partial blocks occurred more frequently when the injection was made after stimulating only the lateral cord, we thought that this location would provide us with better opportunity to examine the relationship between the septae and the distribution of local anesthetic. [3][4][5][6]11 Klaastad et al 12 reported uneven local anesthetic spread on magnetic resonance imaging examination after single injection axillary brachial plexus blocks. In our study, approximately 20% (six of 28) of patients had unilateral spread of the local anesthetic after one injection when the infraclavicular brachial plexus was approached from the lateral direction.…”

“…Because all observed septae were located in posterolateral aspect of the axillary artery, local anesthetic was not seen to reach the posterior cord in cases of suspected septal presence, as has been shown to provide the most effective anesthesia. [3][4][5][6] This may explain the high failure rate of the single lateral injection technique. This finding also agrees with a recent study that examined the relationship between the local anesthetic spread and the infraclavicular block success.…”

“…11 It is generally accepted that multiple injections improve the success of infraclavicular brachial plexus blocks. 4,5 However, one of the criticisms of the multiple injection technique is its potential to increase complications. 5 By selectively performing multiple injections only when the local anesthetic spread is unilateral, our blocks were 100% successful without any complication.…”

“…4,5 However, one of the criticisms of the multiple injection technique is its potential to increase complications. 5 By selectively performing multiple injections only when the local anesthetic spread is unilateral, our blocks were 100% successful without any complication. The use of ultrasound effectively determined the adequacy of a single injection by visualizing the circumferential spread of the local anesthetic in the infraclavicular region.…”

“…1,2 With the use of nerve stimulators, the success rate of the single injection technique was as low as 44%, especially when only the lateral cord was stimulated. [3][4][5][6] We hypothesized that ultrasonographic identification of septae may be beneficial in performing infraclavicular brachial plexus blocks. The purpose of this study was to ultrasonically identify the presence of septae within the neurovascular sheath and to assess their possible effect on local anesthetic spread.…”