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Randomized Controlled Trial
. 2012 May;24(3):196-200.
doi: 10.1016/j.jclinane.2011.07.013. Epub 2012 Apr 5.

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

Affiliations
Randomized Controlled Trial

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

Framarz Mosaffa et al. J Clin Anesth. 2012 May.

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.

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