A systematic review of ultrasound‐guided methods for brachial plexus blockade

Abstract

SummaryWe systematically reviewed 25 randomised controlled trials of ultrasound-guided brachial plexus blockade that recruited 1948 participants: either one approach vs another (axillary, infraclavicular or supraclavicular); or one injection vs multiple injections. There were no differences in the rates of successful blockade with approach, relative risk (95% CI): axillary vs infraclavicular, 1.0 (1.0-1.1), p = 0.97; axillary vs supraclavicular, 1.0 (1.0-1.1), p = 0.68; and infraclavicular vs supraclavicular, 1.0 (1.0-1.1), p = 0.32. There was no difference in the rate of successful blockade with the number of injections, relative risk (95% CI) 1.0 (1.0-1.0), p = 0.69, for one vs multiple injections. The rate of procedural paraesthesia was less with one injection than multiple injections, relative risk (95% CI) 0.6 (0.4-0.9), p = 0.004.

Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach: A Randomized Observer Blind Trial

“…The efficacy of these three techniques has been compared in several previous studies relative to a wide range of outcome variables [1–10]. A very recent systematic review of 25 randomized controlled trials of USG BP blockade found no differences in the rate of successful blockade with approach or with number of injections [11]. In the same review, only one randomized controlled trial was reported to have compared all three techniques in the same study [1, 11].…”

“…A very recent systematic review of 25 randomized controlled trials of USG BP blockade found no differences in the rate of successful blockade with approach or with number of injections [11]. In the same review, only one randomized controlled trial was reported to have compared all three techniques in the same study [1, 11]. Tran et al [1] found no differences between groups with respect to total anesthesia-related time, success rate, and block-related pain scores.…”

Retroclavicular vs supraclavicular brachial plexus block for distal upper limb surgery: a randomised, controlled, single-blinded trial

“…Based on a recent meta-analysis published by our group, the success rate of a supraclavicular block with a single injection was 86%. 1 We anticipated a 15% increase in the success rate with a retroclavicular approach. Assuming an alpha error of 0.05 and a power of 70%, we calculated that 48 patients per group were required to detect a statistically significant difference.…”

“…A volume of 30 ml was chosen, as this is the most popular volume injected in most trials included in a recent meta-analysis that investigated ultrasound-guided supraclavicular or infraclavicular brachial plexus blocks. 1 After completion of the block, patients remained fully monitored until their transfer to the operating room.…”

“…Regional anaesthesia for distal upper limb surgery is routinely performed with supraclavicular, infraclavicular, or axillary brachial plexus blocks. 1 In the authors' experience, the supraclavicular block is the method of choice in a busy ambulatory centre because of its average onset time of <10 min. 2 Recently, a new ultrasound-guided approach to the brachial plexus has been reported on a case series of 50 patients, named the retroclavicular block.…”