Median Versus Musculocutaneous Nerve Response with Single-Injection Infraclavicular Coracoid Block

Single-Stimulation, Low-Volume Infraclavicular Plexus Block: Influence of the Evoked Distal Motor Response on Success Rate

“…13 Anatomic considerations may explain our results. We believe that ILVA is a different approach of the brachial plexus of nerves than that proposed by Gaertner et al 13 and Rodriguez et al 9,16,17 Indeed, both authors used a coracoid approach of the brachial plexus of nerves, but they certainly reached neural structures in the coracoid space situated below the superior edge of pectoralis minor muscle. Conversely, we placed ILVA combining both a supracoracoid lateral puncture and a vertical direction of needle.…”

“…Increasing the volume might have obscured the differences we measured. Indeed, the influence of the volume of local anesthetic solution upon success rate of any block is obvious, although Rodriguez et al 9,16 were still able to find some differences in the extent of musculocutaneous or median nerve fibers with 40 mL of the same drug we used. Moreover, we have recently shown that 30 mL injected after radial-type nerve stimulation promoted more than 90% success rate of ILVA.…”

“…Blind assessment of the quality of ILVA was performed 20 to 25 minutes after the block was placed, and motor block was not considered as a primary endpoint variable. Rodriguez et al 16 showed that complete anesthesia below the shoulder, even with distal stimulation, cannot be achieved predictably within 20 minutes of single injection technique, and Weller and Gerancher 18 recommend testing the block at 30 minutes. Although we have applied strict criteria for success of ILVA, delayed evaluation of the quality of the block might have limited the differences we observed among groups.…”

Single-Injection Brachial Plexus Anesthesia for Arteriovenous Fistula Surgery of the Forearm: A Comparison of Infraclavicular Coracoid and Axillary Approach

“…1,2 In addition, a motor stimulation response of median nerve in single-stimulation infraclavicular coracoid approach to brachial plexus appears to be associated with good sensory block of the radial nerve, which may have enabled pain-free surgery also in the innervation area of that nerve. 11 In fact, in lateral infraclavicular approaches, the initial motor response is often from the median nerve stimulation, 12 and single injection of a large local anesthetic dose (volume) provides analgesia also of the ulnar and radial nerves. 11 Nearly all of our patients were very satisfied or satisfied with their regional anesthesia.…”

“…11 In fact, in lateral infraclavicular approaches, the initial motor response is often from the median nerve stimulation, 12 and single injection of a large local anesthetic dose (volume) provides analgesia also of the ulnar and radial nerves. 11 Nearly all of our patients were very satisfied or satisfied with their regional anesthesia. Only one of our axillary group patients (i.e., the one with an epinephrineinduced acute cardiovascular episode) experienced the placement of the block as uncomfortable.…”