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Saudi J Anaesth. 2019 Jan-Mar;13(1):35-39. doi: 10.4103/sja.SJA_737_17.

Comparative evaluation of two approaches of infraclavicular brachial plexus block for upper-limb surgeries.

Author information

Department of Anaesthesia, AIIMS, Patna, Bihar, India.
Department of Anaesthesiology, AIIMS, New Delhi, India.
Department of Orthopedics, AIIMS, Patna, Bihar, India.



Infraclavicular approach is a common technique of brachial plexus block. The main difficulty of ultrasound guided technique is in needle visualization due to deep location of the cords. Hebbard et al described a retroclavicular approach wherein the needle was inserted posteriorly to the clavicle.

Materials and Methods:

In this prospective randomized controlled study, we have compared the classical technique with the retroclavicular approach in terms of needle visibility, block success rate, number of needle passes, block performance time, procedure-related pain, complications, patient and operator comfort and satisfaction.


The rate of block success was similar in both the groups. The needle tip and shaft visibility was more in the retroclavicular group (P < 0.05). The number of needle passes was also less in the retroclavicular group. Time for the block procedure was less in retroclavicular group when compared to the classical coracoid group. The patients reported less pain in retroclavicular group (P < 0.05).


Retroclavicular approach is a feasible option of infraclavicular brachial plexus block in Indian Subpopulation in terms of needle visibility and block success rate.


Coracoid approach; needle visibility; retroclavicular

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