The Effect of Infraclavicular Brachial Plexus Blocks on the Axillary Nerve

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To the Editor:
We would like to comment on a recently published and interesting letter from Dr Bansal et al.1 They claim that “blockade at the level of the cords tends to result in inconsistent coverage of the axillary nerve.” We disagree with this statement, based on our clinical experience and studies.
In a recent study of arthroscopic shoulder surgery, 20 patients received a triple block including an infraclavicular block with 31 mL ropivacaine 0.75%.2 At 30 minutes after the blocks, 18 patients were anesthetic in the skin territory of the axillary nerve, whereas the remaining 2 patients had analgesia. All of the patients were paralytic for elevation of the upper limb in the sagittal plane. These data are corroborated by former studies where our infraclavicular method has been used.3,4 Considering shoulder patients and the search for distal alternatives to interscalene block, we think that the results of the 3 studies support the idea of using infraclavicular blocks also to anesthetize the axillary nerve.

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