Comparison of axillary approach and lateral saggital approach on ultrasound guided infraclavicular brachial plexus block

Recently, using regional anesthesia techniques rates are increasing because of the complications associated with general anesthesia. Infraclavicular brachial plexus block for distally shoulder surgery on upper extremity is being popular due to high successful results in last years. In this study, we aimed to show axillary approach is as effective as lateral saggital approach, and more reliable technique for infraclavicular block. Patients included in the study, who need emergency or elective surgery for elbow, forearm, wrist and hand. Patients were between 18 – 65 age, ASA I-III and 40 – 120 kg weight. Patients were randomly divided into two equal groups of 20 people for study: Lateral sagittal infraclavicular approach block group (Group L) (n = 20) and axillary infraclavicular approach block Group A (n = 20). 2 mg of midazolam and 1 mcg / kg of fentanyl were administered intravenously to all patients before block. 30 ml %0.5 bupivacaine injected on posterior cord of brachial plexus on tip to the 8 o-clock position of axillary artery by ultrasound guidance (verified with the peripheral nerve stimulation if required). Local anesthetics distribution was observed by ultrasound. Additional orientation and injection applied in case of insufficient distribution. Sensory peripheral nerve block evaluation was recorded at 5th, 10th, 15th and 20th minutes after block. Motor block evaluation was recorded at 30th minute after block. No statistical difference was found between groups at 20th and 30th minutes about either sensorial block or motor block (p>0.05). Paresthesia was seen in two patients in Group A and five patients in Group L. No statistical significant difference was found between groups (p>0.005). Block success rates were found 95% in group A and 100% in Group L. As a result, the ultrasound guidance of axillary approach for infraclavicular brachial plexus block can be an effective and safe alternative .