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1,001 Subclavian Perivascular Brachial Plexus Blocks: Success With a Nerve Stimulator
  1. Carlo D. Franco, M.D. and
  2. Zairo E.G. Vieira, M.D.
  1. From the Department of Anesthesiology, Cook County Hospital, Chicago, Illinois; and the Department of Anesthesiology, Rush Medical College, Chicago, Illinois.
  1. Reprint requests: Carlo D. Franco, M.D., Department of Anesthesiology and Pain Management, Cook County Hospital, 1835 West Harrison St, Suite 7308, Chicago, IL 60612-3789.


Background and Objectives Among the supraclavicular approaches to the brachial plexus, the subclavian perivascular technique is a well-established method of anesthesia of the upper extremity. Ever since Kulenkampf described his technique, eliciting a paresthesia has been almost mandatory (“no paresthesia, no anesthesia”). Lately, nerve stimulators have become more popular. However, up to the present time, clinical studies involving the nerve stimulator have failed to show success rates comparable to paresthesia techniques.

Methods Data from 1,001 consecutive, subclavian perivascular blocks were prospectively gathered over 2.5 years. All blocks were performed according to Winnie's technique, but using a nerve stimulator instead of a paresthesia. When an adequate response was obtained, 35 to 40 mL of local anesthetic solution was injected.

Results Nine hundred seventy-three blocks (97.2%) were completely successful; 16 blocks (1.6%) were incomplete and needed supplementation; and 12 blocks (1.2%) failed and required general anesthesia, giving a success rate for regional anesthesia of 98.8%.

Conclusions The subclavian perivascular block consistently provides an effective block for surgery on the upper extremity. At the site of injection with this technique, the plexus is reduced to its smallest components and the sheath is reduced to its smallest volume, which explains in great part the success obtained with this block. We believe that we have demonstrated a nerve stimulator technique that is both highly successful and safe; no clinical pneumothorax was found nor did any other major complications develop.

  • Subclavian perivascular brachial block
  • Nerve stimulator
  • Success rate
  • Upper extremity

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  • Presented in part at the International Symposium in Orthopaedic Anaesthesia in Rome, Italy, May 1997; at the ESRA Annual Meeting in Geneva, Switzerland, September 1998; and at the ASRA Annual Meeting in Philadelphia, Pennsylvania, May 1999.