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PubMed2005

Cephalometric variables to predict future success of early orthopedic Class III treatment.

BACKGROUND: The objective of this study was to select a model of cephalometric variables to predict future Class III growth patterns based on the results of early orthopedic treatment with a protraction facemask. MATERIAL: Sixty-four patients with Class III malocclusion were treated with a protraction facemask. Cephalometric radiographs were taken before treatment and a minimum of 3 years after treatment. The sample was divided into 2 groups: successful and unsuccessful according to overjet and molar relationships. Eleven linear and 5 angular measurements were made on the pretreatment radiograph. A logistic regression model was used to identify the dentoskeletal variables most responsible for the prediction of successful and unsuccessful outcomes in subjects receiving treatment. RESULTS: Stepwise variable selection generated 4 variables significant in predicting successful treatment outcomes: position of the condyle with reference to the cranial base (Co-GD, P = .02), ramal length (Co-Goi, P = .03), mandibular length (Co-Pg, P = .01), and gonial angle (Ar-Goi-Me, P < .0001). The gonial angle was found to be significantly larger in the unsuccessful group. Controlling for other variables, the probability of successful treatment is an increasing function of Co-GD and Co-Goi, and a decreasing function of Co-Pg and Ar-Goi-Me. A logistic equation was established that is accurate in predicting successfully treated Class III patients 95.5% of the time and unsuccessful ones 70% of the time. CONCLUSIONS: These results suggest that Class III growing patients with forward position of the mandible, small ramal length, large mandibular length, and obtuse gonial angle are highly associated with unsatisfactory treatment outcomes after pubertal growth.

Age Factors↗

PubMed2004

Cesarean delivery after successful external cephalic version of breech presentation at term: a comparative study.

OBJECTIVE: The purpose of this study was to evaluate the rate and indications of cesarean delivery after a successful external cephalic version. STUDY DESIGN: A case-control study was performed from patients who were delivered in a tertiary care center between 1987 and 2000. Each patient who underwent a successful external cephalic version (study group) was compared with the next woman with the same parity, who was delivered at term (control group). Nulliparous and multiparous women were analyzed separately. Chi-squared, Mann-Whitney, and Student t tests were used for statistical analysis. Multivariate logistic regression analysis was performed where appropriate. RESULTS: A total of 602 patients were included in this study. The rates of cesarean delivery in nulliparous women (29.8% vs 15.9%; P<.001) and in multiparous women (15.9% vs 4.7%; P<.001) were significantly higher when compared with the control group. Patients with successful external cephalic version were more likely to have a cesarean delivery for dystocia (nulliparous, 22.5% vs 11.9%; P=.01; multiparous, 10.9% vs 1.3%; P<.01). After an adjustment for confounding variables, a successful external cephalic version was associated with an increased rate of cesarean delivery at term (nulliparous: odds ratio, 2.04; 95% CI, 1.13-3.68; multiparous: odds ratio, 4.30; 95% CI, 1.76-10.54). CONCLUSION: The rate of cesarean delivery for dystocia is increased after a successful trial of external cephalic version in both nulliparous and multiparous women.

Adult↗

PubMed2006

Temporal trends in the rates of trial of labor in low-risk pregnancies and their impact on the rates and success of vaginal birth after cesarean delivery.

OBJECTIVE: The national rate of vaginal birth after cesarean delivery decreased by 55% between 1996 and 2002. The objective of this investigation was to determine, in our population in upstate New York, whether this decline in the vaginal birth after cesarean delivery rate was due to temporal changes in the trial of labor rates or in the vaginal birth after cesarean delivery success rates. STUDY DESIGN: Regional perinatal databases were used to obtain birth certificate data from a total of 135,833 live births in upstate New York from 1998 to 2002. Trial of labor, vaginal birth after cesarean delivery, and vaginal birth after cesarean delivery success rates were calculated for the 11,446 women who had had a previous cesarean delivery and a singleton, low-risk pregnancy at > or = 37 weeks of gestation. Additional factors that were analyzed included age, race, education, insurance, body mass index, parity, gestation, area of residence, prenatal care provider, size of hospital, and level of newborn nursery specialization. Tests for trends were conducted by year for each of the variables. RESULTS: The trial of labor rate declined 39% from 58.7 in 1998 to 35.7 per 100 eligible women in 2002 (P < .01). The decline in trial of labor rates persisted after stratification within almost all groups (P < .01). The overall vaginal birth after cesarean delivery rate decreased 44%, from 42.7 in 1998 to 24.1 per 100 eligible women in 2002 (P < .01). The decline in vaginal birth after cesarean delivery rates persisted after stratification within almost all groups (P < .01). The rate of vaginal birth after cesarean delivery success was unchanged from 1998 to 2002 (P = not significant). CONCLUSION: We found a major decline in trial of labor and vaginal birth after cesarean delivery rates in low-risk women from 1998 to 2002. There was no change in vaginal birth after cesarean delivery success in those patients who attempted trial of labor. This suggests that the decline in the vaginal birth after cesarean delivery rates that have been observed nationally may be due to a decline in trial of labor attempts and not to a change in vaginal birth after cesarean delivery success rates. The steep declines in trial of labor attempts and vaginal birth after cesarean deliveries suggest that there was a rapid change in the perception of optimal treatment practices for these patients by obstetricians.

Adult↗

PubMed2004

[Are there predictive items of successful surgery in morbid obesity treated by adjustable gastric banding: a prospective study].

BACKGROUND: Surgical treatment of morbid obesity by perigastric adjustable banding give at mid term follow up, contrasted results which associate success, failure and intermediate situations. AIMS: The objective of this work was to prospectively validate predicting items that would predict success in the surgical treatment of morbid obesity by adjustable gastric banding. MATERIAL AND METHODS: Eighty patients with morbid obesity have been treated with adjustable gastric banding. Seventy-one women, and nine men with a mean age of 37.8 years (20-59) with a mean follow up of 17 months (12-52). They have been classified in three groups: success, failure, and intermediate results. Uni- and multivariate analysis was performed on six criteria: age, sex, professional activity, metabolic disorders, length of obesity and body mass index (BMI). RESULTS: Concerning age, sex, professional activity, metabolic disorders, and length of obesity, there was no difference between the three groups. However, a BMI more than 50 kg/m(2) has a strong predictive value. Patients called "super obese", BMI >50, has a high rate of failure (64%) even the weight loss is often important in absolute value, but the BMI at the follow up remain high and more than 40. In this situation: gastric banding does not seem a good treatment because it does not protect these patients against the lethal risk of their comorbidities. CONCLUSION: In this study, there is not a specific candidate "profile" to a successful treatment of morbid obesity by adjustable gastric banding. Meanwhile the initial BMI appear to be a predictive factor of success or failure. In the case of patients with high BMI >50 (super obese) gastric banding did not seen to be a good treatment and another technical approach (gastric bypass) must be discussed.

Adult↗

PubMedDate not supplied

Successful aging in centenarians: myths and reality.

The term "successful aging" appeared in the first issue of "The Gerontologist" in 1961. During the successive years, this expression has changed its meaning. Nowadays, successful aging means "absence of diseases and disabilities, maintenance of high levels of physical and cognitive abilities, preservation of the social and productive activities". It has become a common opinion that the centenarians may represent the prototypes of the successful aging. This motivated our work to study the clinical, psychical, and functional aspects in a centenarian group, verifying the real autonomy, instrumental capacities, and working abilities. Our study pool consisted of 602 centenarians, who were also subjects of then epidemiological studies of the Italian Multicenter Studies on Centenarians (IMUSCE). All subjects underwent a clinical-anamnestic evaluation, cognitive-functional tests by means of the mini mental state examination (MMSE), the independence index in activities of daily living (ADL), the instrumental activities of daily living (IADL) scale. The centenarians were classified in three groups, according to the criteria elaborated previously by us, based on their psychophysical status and autonomy, as follows. Group A: centenarians in good health status; Group B: centenarians in an intermediate health status. Group C: centenarians in bad health status. Group A represented 20.0% of the total pool, Group B amounted to 33.4%, and the Group C was 46.6%. The centenarians of Group A presented normal ADL values, and 47.9% of them were autosufficient in all functions; 5.7% of them were independent in all IADL items. These data confirm that the centenarians of Group A are free of invalidating chronic diseases, are autonomous, maintain good physical and cognitive capacities, however, have not maintained any social or productive activities. Therefore, they cannot be considered as prototypes of successful aging.

Activities of Daily Living↗

PubMed2007

Successful aging: from phenotype to genotype.

Despite worldwide interest in the increasing human "healthspan," inadequate experimental attention has been dedicated to identifying genetic influences on successful aging beyond those that influence longevity alone. Although it is an under-studied topic, some promising leads have emerged from the existing genetic studies of successful aging. Here we describe the results of a systematic review of published family, twin, linkage, and association studies of successful aging that evaluated at least one other characteristic of healthy aging in addition to longevity. We identified 29 studies that met our criteria. Although methodological inconsistencies in sampling and phenotypes were frequent, we found evidence for a substantial genetic contribution to successful aging, including several specific genes (APOE, GSTT1, IL6, IL10, PON1, and SIRT3) that are promising candidates for future molecular genetic research. In addition to reviewing this literature, we provide recommendations for advancing our understanding of the genetic basis of successful aging.

Aged↗

PubMed2005

A comparison of a 'J' wire and a straight wire in successful antegrade cannulation of the superficial femoral artery.

AIMS: To evaluate the success of two different types of wire in common use in their ability to successfully cannulate the superficial femoral artery (SFA) using antegrade puncture. METHODS: 50 consecutive patients in whom antegrade infra-inguinal intervention was planned, underwent common femoral arterial puncture and then cannulation with either a standard 3mm 'J' wire or a floppy tipped straight wire (William Cook-Europe). The frequency with which each type of wire entered the SFA or profunda femoris artery without image guidance was recorded. Further analysis was also made of the success of manipulation of the wire into the SFA following profunda cannulation and the use of alternative guide wires. RESULTS: In 19 out of 25 (76%) patients the 'J' wire correctly entered the SFA without image guidance. Only 5 out of 25 (25%) of straight wires entered the SFA with the initial pass (p < 0.0001). Following further manipulation with the same wire all except 1 'J' wire was successfully negotiated into the SFA. The same was true for only 9 of the remaining straight wires with 11 patients requiring an alternative guide wire. CONCLUSIONS: When performing antegrade cannulation of the SFA a 'J' wire is more likely to be successful than a straight guide wire.

Arterial Occlusive Diseases↗

PubMedDate not supplied

A program for successful integration of international medical graduates (IMGs) into U.S. surgical residency training.

OBJECTIVE: U.S. surgery residency programs have traditionally attracted international medical graduates (IMGs). However, the qualifications and performance of IMGs are variable and difficult to predict. Poor performance negatively affects patient care, the residency program, and the IMGs. We sought to identify causes of poor performance and to develop a program to identify those with chances to succeed. DESIGN: Longitudinal study. Retrospective analysis. Description of a new program. SETTING: University of Washington, a tertiary care teaching hospital. PARTICIPANTS: Performance of former IMG residents was reviewed to define the most common reasons for failure. In August 2002, we developed an IMG Certificate Program that enrolls IMGs into a formal 8-week clinical experience with duties, responsibilities, and evaluations similar to fourth-year medical students. A final global score is given for potential for success as a resident in our program. RESULTS: Poor performance in past IMG residents could be attributed to: credential problems and poor performance. Performance problems were further subdivided to include knowledge issues and personal/cultural issues. Since August 2002, our Certificate Program enrolled 15 IMGs. Fourteen graduated, and 10 were offered preliminary spots in our program: 4 are successful interns, 1 returned to Italy, and 5 will start in 2004. One entered the 2004 match in Anesthesiology, and 1 was counseled to not be a candidate for a U.S. program. Three had above average performance and were felt to be better suited to a smaller program (1-2 hospitals). The mean "potential for success" global score was 3.9 (all grads), 4.6 (current interns), 1.0 (nongraduate), and 3.0 for the above average performers better suited to a smaller U.S. program. CONCLUSIONS: We developed a program that provides IMGs an 8-week clinical experience in a busy U.S. training program; it provides them with enough experience to successfully integrate into a U.S. residency and identifies those with better chances to succeed. Wide application of this program and exchange of information among program directors may facilitate recruitment and the successful completion of training of IMGs and provide the number of residents needed to fill critical positions in the United States.

Certification↗

PubMed2005

Delayed vasectomy success in men with a first postvasectomy semen analysis showing motile sperm.

OBJECTIVE: To determine the frequency of and factors associated with delayed vasectomy success in men with first postvasectomy semen analysis showing motile sperm. DESIGN: Descriptive study. SETTING: One hospital-based family planning clinic and two private clinics from the Quebec City area, Canada. PATIENT(S): Three hundred nine men vasectomized between 1990 and 2001 and who had a first semen analysis showing motile sperm. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Vasectomy success, based on the last available semen analysis-either in the medical record or as requested for the study-and on sterility as established by a telephone-based questionnaire in 2003. RESULT(S): Among the 309 men, 174 (56.3%, 95% confidence interval 50.7%-61.7%) had delayed vasectomy success. Significant independent factors associated with delayed vasectomy success were lower sperm count in the first postvasectomy semen analysis and shorter interval between vasectomy and first postvasectomy semen analysis. CONCLUSION(S): Delayed vasectomy success occurs in more than half of men with a first postvasectomy semen analysis showing motile sperm. The decision to repeat vasectomy should not rely on a single semen analysis showing motile sperm.

Adult↗

PubMed2006

Comparison of success rates in the medical management of ectopic pregnancy with single-dose and multiple-dose administration of methotrexate: a prospective, randomized clinical trial.

OBJECTIVE: To assess whether success rate differs in single-dose versus multiple-dose administration of methotrexate (MTX) in medical management of unruptured ectopic pregnancies. DESIGN: Prospective randomized clinical trial. SETTING: Tertiary university hospital. PATIENT(S): The study population included 108 patients presenting with unruptured ectopic pregnancies who fulfilled the criteria for medical management. INTERVENTION(S): A single dose (study group) or multiple doses (control group) of MTX were administered IM. MAIN OUTCOME MEASURE(S): Success rate of medical management in each group. RESULT(S): Of the 54 patients on the single-dose protocol, treatment was considered successful in 48 patients (88.9%). Of the 54 patients on the multiple-dose protocol, 50 participants responded to the treatment (92.6%). The difference between success rates in the two groups was not statistically significant (P=.7; odds ratio 0.64; 95% confidence interval 0.17-2.4). In the single-dose and multiple-dose groups, 15 (27.8%) and 20 (37%) patients, respectively, had complications (P=.3). CONCLUSION(S): The results of our study showed that single-dose treatment with MTX could be as successful as multiple doses. The incidence of complications did not differ between the two groups. It appears that single-dose treatment could be the first line of treatment in selected patients.

Adult↗

PubMed2003

Does failure breed success: narrative analysis of stories about computerized provider order entry.

OBJECTIVE: To assess the definitions of success and failure as defined by the participants of the Menucha Consensus Conference on Computerized Provider Order Entry (CPOE). DESIGN: Thirteen experts from various fields participated in Menucha Consensus Conference. Though they belonged to different fields, all of them had some kind of experience in CPOE implementation. MEASUREMENTS: The stories of these experts were analyzed using a constant comparison method and partially ordered display. RESULTS: Each participant told a success and a failure story. Definitions of success and failure, as well as variables contributing to the success and failure of CPOE implementations, were extracted from the transcripts. CONCLUSION: Analysis reveals that what is considered a failure is context dependent and that it often is an antecedent to success.

Decision Support Systems, Clinical↗

PubMed2004

Does beta-blocker therapy improve clinical outcomes of acute myocardial infarction after successful primary angioplasty?

OBJECTIVES: We sought to determine if beta-blocker therapy improves clinical outcomes of acute myocardial infarction (AMI) after successful primary percutaneous coronary intervention (PCI). BACKGROUND: We have shown that pre-treatment with beta-blockers has a beneficial effect on short-term clinical outcomes in patients undergoing primary PCI for AMI. It is unknown if beta-blocker therapy after successful primary PCI improves prognosis of AMI. METHODS: We analyzed clinical, angiographic, and outcomes data in 2442 patients who underwent successful primary PCI in the Primary Angioplasty in Acute Myocardial Infarction-2 (PAMI-2), PAMI No Surgery-on-Site (PAMI noSOS), Stent PAMI, and Air PAMI trials. We classified patients into beta group (those who received beta-blockers after successful PCI, n = 1661) and no-beta group (n = 781). We compared death and major adverse cardiac events (MACE) (death, reinfarction, and ischemia-driven target vessel revascularization) at six months between groups receiving and not receiving beta-blockers. RESULTS: At six months, beta patients were less likely to die (2.2% vs. 6.6%, p < 0.0001) or experience MACE (14 vs. 17%, p = 0.036). In multivariate analysis, beta-blockers were independently associated with lower six-month mortality (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.26 to 0.73, p = 0.0016). Beta-blocker therapy was an independent predictor of lower six-month events in high-risk subgroups: ejection fraction <or=50% (death: OR 0.34, 95% CI 0.19 to 0.60, p = 0.0002) or multi-vessel coronary artery disease (CAD) (death: OR 0.26, 95% CI 0.14 to 0.48, p < 0.0001; MACE: OR 0.57, 95% CI 0.41 to 0.80, p = 0.0011). CONCLUSIONS: Treatment with beta-blockers after successful primary PCI is associated with reduced six-month mortality, with the greatest benefit in patients with a low ejection fraction or multi-vessel CAD.

Adrenergic beta-Antagonists↗

PubMed2004

Residual symptoms in depressed patients who successfully respond to short-term psychotherapy.

BACKGROUND: Most investigations of residual symptoms have focused on partial responders to antidepressant medications. Comparatively few have examined residual symptoms among patients who achieved a more successful response to treatment. In addition, few studies have assessed residual symptoms among patients treated with psychotherapy. The purpose of the present study was to assess residual symptoms of depression among psychiatric outpatients who successfully responded to psychotherapy and determine their association with other important clinical outcomes. METHODS: Sixty patients with major depression who participated in a randomized controlled trial of two forms of short-term, individual psychotherapy were studied. We examined the prevalence of residual symptoms among successful responders, as well as the relationships between residual symptoms, pre-therapy patient characteristics, relapse, and other outcomes. RESULTS: Thirty-three (55%) of the 60 patients responded successfully to psychotherapy. Of those, 82% had residual symptoms. Residual symptoms predicted relapse at 6-month follow-up, and were associated with less favorable psychosocial functioning at post-therapy and at 6-month follow-up. LIMITATIONS: The study consisted of post-hoc analyses of existing data, the number of asymptomatic patients was small, and a proxy measure of relapse was used. CONCLUSIONS: Residual symptoms are prevalent among depressed patients who successfully respond to psychotherapy. Greater residual symptoms appear to increase the risk for relapse and are associated with poorer psychosocial functioning.

Adult↗

PubMed2006

Predictors for resident success in otolaryngology.

BACKGROUND: This study aimed to determine predictors for otolaryngology resident success using data available at the time candidates are interviewed (eg, medical school attended, letters of recommendation, test scores) and data that emerge during residency. STUDY DESIGN: We performed a retrospective cohort study of 36 residents who entered our program between 1983 and 1993. RESULTS: Seventy percent of Alpha Omega Alpha (AOA) members and 13% of nonmembers were in the highest tertile based on faculty ranking (p<0.01), and candidates with an exceptional trait were more likely than those without an exceptional trait to rank in the highest tertile (57% versus 10%, p<0.01). AOA membership was also related to current academic appointment (p=0.02). Significant correlations included United States Medical Licensing Examination (USMLE) I score, year 2 in-training score (0.48, p=0.03), and years 3 and 4 in-training score and faculty ranking (minus 0.39, minus 0.50, respectively, p 50% of the interviewers (p<0.05 for both). CONCLUSIONS: In our program designed to train academic otolaryngologists, postresident success was strongly predicted by having an exceptional trait and AOA membership. Success during residency was predicted by interviewer's impression of the candidate and a USMLE I score>570. Knowledge of these factors at the time of the resident interview could increase the likelihood of selecting the most appropriate candidates for academic otolaryngology. Resident success is a complex outcome, and other unmeasured and unexamined characteristics can provide additional insight into choosing successful residents.

Adult↗

PubMed2004

Characteristics of childhood cancer survivors predicted their successful tracing.

OBJECTIVE: The Childhood Cancer Survivor Study is a retrospective cohort study that was initiated to explore late effects of childhood cancer and its therapies. We evaluated the characteristics of those requiring tracing and factors that influenced tracing success. STUDY DESIGN AND SETTING: Medical record review identified 20,051 eligible individuals from 25 institutions in the United States and Canada. Of these, 13,021 had a current address in the medical record at the treating institution, and 7,030 had an incorrect address and required tracing by a commercial firm. RESULTS: Tracing was successful for 4,188 persons (60%). Younger age at contact, shorter length of time since last contact, having a middle initial available, an uncommon last name, and socioeconomic factors were found to predict successful tracing. Compared to those with a current address available in medical records, subjects successfully traced were less likely to have accessed health care during the previous 2 years; and more likely to be current smokers, obese, and to report moderate to severe impairments (pain, functional status, and activity). CONCLUSION: These findings provide an empirical basis concerning determinants and predictors of tracing success. If tracing had not been performed in this cohort, spurious associations may have been obtained for some health outcomes of interest.

Adolescent↗

PubMed2004

Comparison of cytokine level in synovial fluid between successful and unsuccessful cases in arthrocentesis of the temporomandibular joint.

PURPOSE: The aim of this study was to compare proinflammatory cytokine levels between successful cases and unsuccessful cases of arthrocentesis in patients with internal derangement of the temporomandibular joint (TMJ). PATIENTS AND METHODS: This study involved 73 joints judged as successful and 30 judged as unsuccessful of 103 joints in 100 patients diagnosed with internal derangement of the TMJ and who underwent arthrocentesis. The diluted synovial fluid before undergoing arthrocentesis was aspirated from the superior joint space. The concentrations of interleukin (IL)-1beta, tumor necrosis factor-alpha, IL-6, and IL-8 were measured using an enzyme-linked immunosorbent assay. The differences in the detection rate and concentration of each cytokine between successful cases and unsuccessful cases were analyzed statistically. RESULTS: There was a statistically significant difference between successful cases (72.2%) and unsuccessful cases (95.5%) in the detection ratio of IL-6 (P <.05). There was a statistically significant difference between successful cases (0.017 pg/100 microg protein) and unsuccessful cases (0.046 pg/100 microg protein) in the concentration of IL-1beta (P <.05). CONCLUSION: It has been shown that the presence of IL-1beta and IL-6 in synovial fluid may be indicators of possible unsuccessful treatment following arthrocentesis for internal derangement of the TMJ.

Adolescent↗

PubMedDate not supplied

Effect of cerebrospinal fluid return on success rate of percutaneous retrogasserian glycerol rhizotomy.

BACKGROUND AND OBJECTIVE: Trigeminal neuralgia is a painful syndrome, which has been commonly treated with percutaneous retrogasserian glycerol rhizotomy (PRGR). This study was performed to evaluate the effect of cerebrospinal fluid (CSF) return on the success rate of PRGR. METHODS: In this retrospective, nonrandomized, observational case series, 100 cases underwent 140 PRGRs under fluoroscopic guidance and were followed up for 6 to 36 months. The results were compared in the presence or absence of CSF return before PRGR. RESULTS: The PRGR was successful in 115 procedures (82.1%). CSF return was present in 84 procedures (60%) and, among these, 76 PRGRs (90.5%) produced pain relief. More than 1 year of pain relief without medications was present in 60 of 84 procedures (71.4%). CSF return before PRGR was absent in 56 procedures (40%) and success resulted in 39 procedures (69.6%). Pain relief for more than 1 year without medications was present in 19 procedures (33.9%). The success rate and duration of pain relief was greater in the presence of CSF return compared with absence of CSF return (P < .005). The incidence of complications such as facial dysesthesia (40%), corneal anesthesia (2.8%), herpes simplex (3.5%), and nonbacterial meningitis (0.7%) was not significantly different in 2 groups ( P > .05). CONCLUSION: The presence of CSF is an important factor in determining the success rate and duration of pain relief of PRGR.

Adolescent↗

PubMedDate not supplied

Single-stimulation, low-volume infraclavicular plexus block: influence of the evoked distal motor response on success rate.

BACKGROUND AND OBJECTIVES: We compared the success rate of single-injection infraclavicular plexus block by using electrically evoked radial, ulnar, or median nerve-type distal motor response to guide the injection of local anesthetic. METHODS: Consecutive patients requiring surgery distal to the upper arm were prospectively included in this study over a 6-month period. No search for predetermined distal motor responses was performed. The first qualifying distal motor response evoked for a stimulating current intensity of <0.5 mA distributed patients into 3 groups of patients. The study was continued until 3 groups of 60 patients were fulfilled. Twenty to 25 minutes after the injection of 30 mL of 1.5% mepivacaine, blinded evaluation of block quality was performed. A successful block was defined by the presence of a complete sensory block of the 5 major nerve distal distributions of the arm. RESULTS: Five hundred patients were included. The first evoked distal motor response was of radial, median, and ulnar nerve type in 46% (n = 230), 42% (n = 210), and 12% (n = 60) cases, respectively. The success rate of the infraclavicular plexus block was significantly higher when the injection was performed on a radial nerve-type response (90%) as compared with the median (74%) or ulnar (68%) nerve distal motor response. Intraoperative sedation and general anesthesia were not needed. None of the patients experienced specific complications. CONCLUSION: We showed that evoked distal motor response influenced the success rate of single-injection infraclavicular plexus block. The highest success rate was obtained when injection was performed after radial nerve-type motor response.

Adult↗