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A Comparison of Posterior and Medial Cord Stimulation for Neurostimulation-Guided Vertical Infraclavicular Block: A Randomized Noninferiority Clinical Trial

Yang, Chun Woo MD*; Jung, Sung Mee MD; Kwon, Hee Uk MD, PhD; Kang, Po Soon MD, PhD; Cho, Choon Kyu MD; Oh, Jin Young MD; Lee, Younsuk MD, PhD§; Choi, Junghee MD

doi: 10.1213/ANE.0000000000000143
Regional Anesthesia: Brief Report

BACKGROUND: We investigated whether medial cord stimulation is inferior to posterior cord stimulation for vertical infraclavicular block with respect to block success.

METHODS: Ninety-six patients scheduled for upper limb surgery were randomly elicited a medial or posterior cord response for infraclavicular block using 40 mL of 0.5% ropivacaine. We assessed block success (complete sensory block of the 5 nerves in the forearm at 50 minutes) as the primary end point and block procedure characteristics and adverse events as secondary end points.

RESULTS: The block success rates did not differ significantly between medial and posterior cord stimulation (95.7% [44/46] vs 91.7% [44/48], 95% CI of difference, –7.4% to 15.6%), while the secondary end points were comparable in both groups.

CONCLUSIONS: Needle manipulation to elicit medial cord response is noninferior to posterior cord response of block success during neurostimulation-guided vertical infraclavicular block.

From the *Department of Anesthesiology and Pain Medicine, Cheju Halla General Hospital, Jeju-si, Jeju special self-governing province; Department of Anesthesiology and Pain Medicine, Yeungnam University School of Medicine, Daegu; Department of Anesthesiology and Pain Medicine, Konyang university hospital, Daejeon; §Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang; and Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Accepted for publication January 8, 2014.

Funding: No funding.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Sung Mee Jung, MD, Department of Anesthesiology and Pain Medicine, 170, Hyeonchung-ro, Nam gu, Daegu, 705-717, South Korea. Address e-mail to

© 2014 International Anesthesia Research Society