Correspondence  |   June 2018
In Reply
Author Notes
  • Hospital Intermutual de Levante, Valencia, Spain. carlesgvitoria@gmail.com
  • (Accepted for publication March 8, 2018.)
    (Accepted for publication March 8, 2018.)×
Article Information
Correspondence
Correspondence   |   June 2018
In Reply
Anesthesiology 6 2018, Vol.128, 1259-1260. doi:10.1097/ALN.0000000000002210
Anesthesiology 6 2018, Vol.128, 1259-1260. doi:10.1097/ALN.0000000000002210
We appreciate Dr. Aldwinckle’s interest in our report1  describing the technique of insertion of a supraclavicular catheter through an infraclavicular entry point. With this approach to the brachial plexus we aim for the fixation of an infraclavicular-access catheter using the flat surface of the pectoral musculature cited by Jeng and Rosenblatt2  and the effectiveness of a supraclavicular single shot, leaving the tip in the corner pocket.3 
Regarding safety, the rate of pneumothorax during what was described as the “Apollo space mission” is 0 in our 452 cases collected. At our hospital, a teaching center in the practice of regional anesthesia, approximately 2,000 annual supraclavicular blocks (single shot) are performed. A substantial number of brachial plexus catheters also are placed at the supraclavicular level. The usual approach, lateral to medial supraclavicular access, was used years ago, but its rates of displacement were high, as described in the bibliography Dr. Aldwinckle cited. Infraclavicular catheter insertion, instead, was annoying for the patient due to the depth of the structures involved and had an irregular performance despite placing the dorsal tip toward the artery. About 8 yr ago, a hybrid method (the one we originally reported) was conceived, which combined the advantages of infraclavicular access (better fixation) with that of the supraclavicular (more effective block). Since it began to be used, the rate of vascular punctures has not exceeded 2%.
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