Supraclavicular, infraclavicular, axillary approach comparable for brachial nerve block

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
101 patients undergoing orthopaedic surgery below the shoulder were randomized to receive ultrasound guided brachial plexus block through a supraclavicular, infraclavicular, or axillary approach. The purpose of this study was to determine if there were significant differences in block performance time, quality of nerve block, or proportion of failed blocks when comparing anaesthetic approaches up to thirty minutes after surgery completion. Results demonstrated that Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
Why was this study needed now?
Successful nerve blocks achieved during orthopedic surgery are characterized by reduced analgesic supplementation. Regional blocks are normally initiated through one of three methods: anatomical landmarks (with and without neurostimulation), or guidance with ultrasound imaging. It has been reported that ultrasound-guided approaches provide the greatest accuracy and quality of regional nerve blocks due to enhanced visualization of target structures. The aim of this study was, therefore, to support this claim by examining the success of ultrasound guided brachial plexus block through supraclavicular, infraclavicular, or axillary approaches.
What was the principal research question?
For patients undergoing orthopedic surgery below the shoulder, were there any significant differences between supraclavicular, infraclavicular, or axillary nerve block approaches when performed with ultrasound guidance in terms of success, quality, performance time and correlation with body mass index (BMI)?
Population: 101 patients greater than 18 years of age with ASA score of I-III undergoing various elective orthopedic or vascular surgeries were included in this study. All patients were given 0.5-1 microgram/kg fentanyl and 2-3 mg of intravenous midazolam throughout block. All blocks were performed with 40 mL bupivacaine and adrenaline 1:200,000 without additional neurostimulation. Additional nerves were blocked with subcutaneous local infiltration containing lidocaine 1%.
Intervention: Supraclavicular (SCL) group: patients underwent brachial plexus block administered with a supraclavicular approach (n=37; mean age= 63.62+/-14.77, 15M/22F).
Comparison: Infraclavicular (ICL) group: patients underwent brachial plexus block administered with an infraclavicular approach (n=23; mean age= 63.00+/-21.55, 13M/10F). Axillary (AX) group: patients underwent brachial plexus block administered with an axillary approach (n=34; mean age= 60.71+/-16.42, 20M/14F).
Outcomes: The primary outcome of interest was the percentage of failed blocks in each study group. Other outcomes of interest included block performance guitar, duration of operation, patient discomfort unrelated to pain, appropriate or failed block, and postoperative complications. Duration of block procedure was defined as the time between sterile skin preparation and the termination of local anesthetic and removal of block needle. Failed blocks were defined as requirement of strong opioid adjunct analgesic added to their general anaesthesia or local infiltrative anaesthesia.
Methods: RCT: prospective, assessor-blinded
Time: Nerve blocks were assessed thirty minutes following the end of the procedure.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.