{
  "abstract": "Background and Aims The retroclavicular approach to brachial plexus block (RAPTIR) has gained attention for potentially offering several advantages over traditional techniques. It offers potentially better needle view, reduced risk of vascular puncture and improved patient comfort. This case shows its advantage in a patient with complex anatomy, characterized by a deep deltopectoral groove and a prominent humerus, where the traditional infraclavicular approach is difficult. During this procedure, a linear ultrasound transducer is positioned vertically inferior to the clavicle, lateral to the midclavicular line. The needle is then inserted in a caudad direction, superior and posterior to the clavicle.Methods A 46-year-old man, ASA II, underwent right hand amputation under balanced general anesthesia following a crush injury. At the end of surgery, a brachial plexus block was performed via a retroclavicular approach with continuous catheter placement. Fifteen milliliters of 0.2% ropivacaine were administered. Postoperative analgesia included 10 mL of 0.2% ropivacaine every four hours via the catheter, with additional 5 mL boluses available as needed (1-hour lockout). Systemic analgesics included paracetamol 1 g every 8 hours, metamizole 1 g every 8 hours, and tramadol 100 mg as needed. Pain intensity was assessed using the numeric rating scale immediately after surgery and at 2, 6, 12, 24, 36, and 48 hours postoperatively.Results The patient‘s pain intensity was effectively controlled. At each evaluation the patient reported pain scores of 3 or less. Tramadol administration was not required throughout post-operative period.Abstract P171 Figure 1Ultrasound-guided retroclavicular approach to the brachial plexus (adapted image)Conclusions This demonstrates the potential benefits of the retroclavicular approach for brachial plexus block when dealing with Complex anatomy as seen in this case. Furthermore, the case highlights the apparent opioid-sparing effect of the brachial plexus block with ropivacaine. The patient achieved adequate pain control with minimal reliance on oral opioids.",
  "authors": [
    {
      "affiliations": [
        "Anestesiologia, Centro Hospitalar Lisboa Norte, Lisboa, Portugal"
      ],
      "name": "Jorge Carteiro"
    },
    {
      "affiliations": [
        "Anestesiologia, ULS Santa Maria, Lisboa, Portugal"
      ],
      "name": "Nuno Torres"
    }
  ],
  "title": "P171 Retroclavicular approach of brachial plexus block: an unusual approach with greater advantages",
  "uid": "00552837-7f2a-5f45-b7be-a0c8e125b621"
}