Dual Endpoint Nerve Stimulation Versus Ultrasound in Infraclavicular Block for Hand Surgery

A Randomized Controlled Study Comparing Dual Endpoint Nerve Stimulation With Ultrasound-guided Infraclavicular Block for Hand Surgery.

Current best practice for performance of infraclavicular block dictates the use of a dual-endpoint nerve stimulation technique that still only results in a 79% success rate. Use of an ultrasound-guided technique has the potential to significantly improve success. A randomized, controlled study to evaluate this area remains to be performed and is required to demonstrate to anesthesiologists that an ultrasound-guided approach should supersede nerve stimulation as the technique of choice for infraclavicular block.

Inclusion Criteria:

• Patients undergoing elective upper limb surgery at or below the elbow.
• Patients aged >18 and <80 years
• ASA I-III
• BMI<35

Exclusion Criteria:

• Inability to read, write or speak English. (This is necessary because subjects will have to follow detailed instructions to allow testing of motor and sensory function. It is not feasible to have an interpreter present in the block room during performance of these procedures)
• Contraindication to brachial plexus block
• Existing neurological deficit in the area to be blocked
• Known loco-regional malignancy or infection
• Coagulopathy
• Allergy to local anesthetic agents.
• Chest or shoulder deformities
• Severe respiratory disease
• Healed but dislocated clavicle fracture