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The Ultrasound-Guided Retroclavicular Block: A Prospective Feasibility Study
  1. Jasmin Charbonneau, MD,
  2. Yannick Fréchette, MD,
  3. Yanick Sansoucy, MD and
  4. Pablo Echave, MD
  1. From the Département d’Anesthésiologie, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
  1. Address correspondence to: Pablo Echave, MD, Département d’Anesthésiologie, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Ave Nord, Sherbrooke, Québec, J1H 5 N4, Canada (e-mail: Pablo.Echave{at}USherbrooke.ca).

Abstract

Background and Objectives The aim of this feasibility study was to determine the success rate (sensory and surgical) of the novel retroclavicular block and to thoroughly describe the technique. In addition, needle tip and shaft visibility, needling time, procedural discomfort, motor block success rate, patient satisfaction at 48-hour follow-up, and complications were also recorded.

Methods Fifty patients scheduled for distal upper limb surgery received an in-plane, single-shot, ultrasound-guided retroclavicular block with 40 mL of mepivacaine 1.5% with epinephrine 2.5 μg/mL. Block success was defined as a sensory score of 10/10 for the 5 nerves supplying the distal upper limb at 30 minutes. Surgical success, needle visibility, needling time, axillary artery depth, motor block rate, patient discomfort with technique, satisfaction at 48 hours, and complications were also recorded. All blocks were video-recorded and timed for further independent assessment. A chest x-ray was obtained before discharge.

Results Forty-five patients had a total sensory score of 10/10 at 30 minutes (90% success rate). Surgical success rate was 96%. Mean needling time was 3.77 minutes (25th–75th percentiles, 2.90–6.53 minutes) with a mean axillary artery depth of 3.1 ± 0.7 cm. Procedure-related discomfort (mean visual analog scale, 1.9 ± 1.2) was low. Mean 48-hour patient satisfaction rate (9.2 ± 1.1), mean needle tip (Likert scale, 3.0 ± 0.9), and shaft visibility (3.9 ± 0.9) were high. One vascular puncture and two transient paresthesias were recorded. No pneumothorax was revealed by chest x-ray.

Conclusions In this study, the novel retroclavicular block offered a quick, safe, and reliable alternative for distal arm block. Further studies, comparing this approach with the classic infraclavicular block, are required to validate its efficacy, safety, and reliability.

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Footnotes

  • The authors declare no conflict of interest.

    This work was supported by departmental funding.

    This work was presented in part as an e-poster at the Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine, Chicago, Illinois, in April 2014.

    Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.rapm.org).