An evaluation of the infraclavicular block via a modified approach of the Raj technique

Infraclavicular plexus block has recently become a technique of increasing interest. However, no approach has provided easily identifiable landmarks, good conditions for catheter placement, and lack of complications (mainly pneumothorax). We describe a modified approach of the Raj technique based on the identification of the anterior acromial process, jugular notch, and emergence of the axillary artery within the axillary fossa, with the arm abducted to 90 degrees and elevated by approximately 30 degrees. We evaluated the clinical characteristics of this approach by injecting 40 to 50 mL of ropivacaine 0.6% in 150 patients scheduled for elective surgery of the forearm, wrist, or hand. Success was defined as a sensory block of the 5 nerves with territories distal to the elbow within 30 min after performing the block. The success rate was 97% when a distal response (flexion or extension of the wrist or fingers) was elicited and 44% when a proximal (contraction of the triceps, biceps) was obtained using a nerve stimulator. Complications were rare: aspiration of blood was soon in 2% of patients and hematoma was seen at the puncture site in 0.6%; no pneumothorax occurred. Eleven patients (7%) complained of some pain during the procedure. We conclude that the modified approach of the Raj technique for infraclavicular block is very effective when a distal nerve stimulator response is obtained with a small complication rate and a high degree of patient satisfaction.