{
  "abstract": "Background and Aims Approach to Infraclavicular blocks (ICB) such as the lateral- ICB (L-ICB) and costoclavicular or medial-ICB (M-ICB) are performed for surgeries below the mid arm. In L-ICB, visualization of all the cords may be difficult, needle may not be properly visualized due to steeper angle of insertion and there can be inadequate drug spread, requiring multiple injections. In M-ICB, needle trajectory may be difficult due to probe angulation and presence of vascular structures along the trajectory. Hence, we propose an alternative oblique approach to ICB (O-ICB) to overcome these difficulties. Aim: Ultrasound probe placement and angulation, ease of needle trajectory, single/multiple point injection; block onset, duration, efficacy; Complications- hemi diaphragmatic paresis, pneumothorax, vascular puncture.Methods Total 10 patients of ASA 1 & 2, with both bone forearm fracture planned for ORIF with plating under brachial plexus block were considered. After obtaining written informed consent for BP block, with standard ASA monitoring, using 6–13 MHZ HF linear USG probe, all 10 patients received O-ICB using 20G 100 mm echogenic needle, in-plane approach, with inj. Bupivacaine 0.5%- 20 ml, in aliquots after negative aspiration for air/blood.Results In all patients, procedure was uneventful, no paresthesia on injection, no change in needle trajectory and no vascular/pleural puncture. Complete motor and sensory blockade after 20 min. All patients were comfortable throughout procedure and block lasted 8–10 hours; no rescue block was required; no HDP.Conclusions In O-ICB, the clustered anatomy of cords is visualized lateral to axillary artery similar to M-ICB; but the probe is not as cranially tilted; helping in better needle-probe orientation and visualization. The O-ICB visualizes the cords before they assume their respective positions as in L-ICB; and no sparing or need for rescue blocks, unlike L-ICB. The oblique infra-clavicular approach to brachial plexus block can a better approach considering the disadvantages of Lateral-ICB and Medial-ICB.",
  "authors": [
    {
      "affiliations": [
        "Anaesthesiology, Sancheti Institute of Orthopedics and Rehabilitation, Pune, India"
      ],
      "name": "Himaunshu Dongre"
    },
    {
      "affiliations": [
        "Anaesthesiology, Sancheti Institute of Orthopedics and Rehabilitation, Pune, India"
      ],
      "name": "Sandeep Diwan"
    },
    {
      "affiliations": [
        "Anaesthesiology, Sancheti Institute of Orthopedics and Rehabilitation, Pune, India"
      ],
      "name": "Navveen PM"
    }
  ],
  "title": "P249 Oblique infra-clavicular block: a better approach to brachial plexus block",
  "uid": "c9b255e4-0d29-550a-b9fa-35a8c5556dc1"
}