Continuous Infraclavicular Brachial Plexus Block Using Retrograde Insertion of an Epidural Catheter with Stylet through the Axilla

Background: The continuous infraclavicular brachial plexus block (BPB) has many merits compared to other approaches. However, due to complications and the discomfort felt by patients during the procedure, it has not gained much in popularity. We assumed that the neurovascular sheath is one compartment and placed the catheter deeply into the sheath, as used in the infraclavicular approach, through the axilla. Methods: Patients scheduled for surgery were paired according to their diagnoses and sites of surgery. Thirty-two patients were randomly chosen and divided into two groups. Selander's continuous axillary BPB was performed in the axillary group. In the infraclavicular group, we inserted an epidural catheter with a stylet deeper into the site just medial to the coracoid process using a C-arm and nerve stimulator. Results: In the infraclavicular group, sensory and motor block of the musculocutaneous nerve and the quality of BPB was superior to those of the axillary group (P ＜ 0.05). The average depth of the catheter from the skin was cm. Conclusions: Continuous infraclavicular BPB can cause no more discomfort as Selander's continuous axillary approach. Furthermore, it may improve the quality of block and reduce the amount of local anesthetic used.