Ultrasound-guided infraclavicular block supplementation is possible during hand surgery

The use of ultrasound provides clinicians the ability of doing nerve blocks that would not be feasible with the aid of nerve stimulator alone. It is helpful when motor response to nerve stimulation is difficult or even impossible to evaluate in cases like arthrodesis, total absence of a joint or already blocked extremity during ongoing surgery. A 28 years old ASA I female patient presented for right forearm surgery for nerve and tendon injury due to trauma. She had an ultrasound guided lateral sagittal infraclavicular block (LSIB) using a relatively low dose local anesthetic mixture (10 ml of lidocaine 2% and 10 ml of 0.75% levobupivacaine). Twenty minutes after block pain free surgery started. Two hours after the start of surgery patient had some pain on surgical site. Instead of converting to general anesthesia we decided to supplement the block with the guidance of ultrasound. Using LSIB technique 10 ml of lidocaine 2% was administered directly posterior to axillary artery. Patient was pain free within a few minutes and surgery was completed uneventfully within 45 minutes. Although incomplete blocks before surgery starts can be supplemented by different means, intraoperative pain perception often results in conversation to general anesthesia. We believe that with the aid of ultrasound guidance intraoperative block supplementation is possible thus the need to convert to general anesthesia during prolonged surgery or incomplete blocks can be avoided during hand surgery.