Case series: ultrasound-guided supraclavicular block using a curvilinear probe in 104 day-case hand surgery patients.

PURPOSE: To report our experiences regarding the implementation of a combined ultrasound and nerve stimulation guidance technique for supraclavicular blockade in day-case hand surgery patients at our institution.

CLINICAL FEATURES: We retrospectively reviewed 104 patient charts from the first 6 months of our clinical practice of using this block approach for upper extremity surgery. Block success, completion and recovery time, post-block analgesia requirement, acute complication rate, and duration of hospital stay were evaluated and categorized based on the practitioner who performed the block (fellow/staff anesthesiologists and residents), as well as the body mass index of the patient (when available). During the performance of each block, the brachial plexus was viewed using a curvilinear probe, and the needle was advanced in-plane in an anterolateral-to-posteromedial direction. The plexus, needle, and spread of local anesthetic could be clearly visualized in each case. Surgical regional anesthesia was achieved in 94.2% of blocks. The block was the sole method of postoperative analgesia in 85.6% of patients, and the overall block completion time was 20.2 +/- 9.2 min. There were no occurrences of clinical pneumothorax during the study period.

CONCLUSIONS

We report our successful experience using ultrasound guidance and nerve stimulation during supraclavicular blockade. The curvilinear probe enables a large field of view, adequate resolution in larger patients, and excellent needle visibility that allows access to the plexus while avoiding the pleura and subclavian artery.