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

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.