A Prospective, Randomized Comparison Between Ultrasound-Guided Supraclavicular, Infraclavicular, and Axillary Brachial Plexus Blocks

Abstract

Adjunctive ultrasonography results in similar success rates, total anesthesia-related times, and block-related pain scores for the SCB, ICB, and AXB.

Ultrasound-guided regional anesthesia for upper limb surgery

“…Several recent studies have shown that the supraclavicular approach does not provide a shorter onset time or a more reliable block than infraclavicular or axillary blocks. [17][18][19] The ulnar nerve may be missed, with a failure rate as high as 36%. 17,18 The infraclavicular approach has been shown to be equivalent to, if not better than, the supraclavicular approach.…”

“…The axillary approach is another interesting option with an onset time and quality of block similar to the infraclavicular block. 19 All approaches carry the risk of vascular puncture. Axillary blocks are preferred when the risk of bleeding secondary to vascular puncture is a concern, as they are superficial and performed in a compressible area.…”

“…Plusieurs études récentes ont démontré que le bloc supraclaviculaire ne produisait pas un temps d'induction plus court et une anesthésie plus fiable que les blocs infraclaviculaire ou axillaire. [17][18][19] Un défaut d'anesthésie du nerf ulnaire est possible et ce, dans une proportion pouvant atteindre 36% des blocs effectués. 17,18 L'approche infraclaviculaire s'est montrée équivalente, voire supérieure, à l'approche supraclaviculaire.…”

“…Le temps d'induction du bloc et l'anesthésie obtenue sont comparables à ceux que procurent l'approche infraclaviculaire. 19 Toutes les approches comportent un risque de ponction vasculaire. Puisque l'approche axillaire est une technique superficielle dans une région compressible, elle devrait être privilégiée quand le risque de saignement secondaire à une ponction vasculaire est une préoccupation.…”

Evaluating outcomes in ultrasound-guided regional anesthesia

“…Some of these points can be illustrated by comparing three studies that weighed ultrasound-guided supraclavicular against infraclavicular block but arrived at very different results [12][13][14] (Table 1). Arcand et al 12 reported a higher incidence of anesthesia or analgesia in the five terminal nerve distributions of the brachial plexus with the supraclavicular block; Koscielnak-Nielsen et al 13 found the converse to be true; and Tran et al 14 found no difference.…”