Infraclavicular and supraclavicular approaches to brachial plexus for ambulatory elbow surgery: A randomized controlled observer-blinded trial

Dhir, Shalini; Brown, Brigid; Mack, Peter; Bureau, Y; Yu, Jingshu; Ross, Douglas C.

doi:10.1016/j.jclinane.2018.05.005

Cited by 29 publications

(23 citation statements)

References 21 publications

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“…This might be an indicator for the solid experience levels of the anesthesiologists performing the blocks in our study. 25 Needle path lengths and number of hand movements measured by hand motion analysis have been used as a secondary outcome measure in our two previously published studies on needle tip tracking. [3][4][5] Hand motion analysis permits a precise evaluation of dexterity and learning curves during surgical procedures and medical interventions.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasonographic needle tip tracking for in-plane infraclavicular brachialis plexus blocks: a randomized controlled volunteer study

Kåsine

Romundstad

Rosseland

et al. 2020

Reg Anesth Pain Med

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BackgroundOnvision is a new technology for needle tip detection and tracking in ultrasound-guided regional anesthesia. The system consists of a piezoelectric sensor close to the needle tip and an electronic console integrated in the ultrasound system. The needle tip is visualized by a green circle on the ultrasound screen. The aim of the study was to investigate the effect of the new needle tip tracking technology on in-plane infraclavicular plexus blocks.MethodsThe study was a randomized, controlled, observer blinded cross-over trial in 26 healthy volunteers. Two specialists in anesthesiology performed an ultrasound-guided infraclavicular lateral sagittal brachial plexus block with and without needle tip tracking. Primary outcome was procedure time, measured from insertion of the needle until local anesthesia injection was completed. Secondary outcome measures included the number of hand movements and path lengths (assessed by hand motion analysis), block success rate, onset time and duration, discomfort experienced by the volunteers, and the anesthesiologists’ confidence as to whether their block would be successful or not.ResultsMean (SD) procedure time was 183.0 (56.1) s with and 206.8 (56.2) s without needle tip tracking (p=0.16). There were no significant differences in any of the secondary outcomes. Two volunteers’ experienced Horner syndrome after blocks without needle tip tracking. No other adverse events occurred during the study.ConclusionOur study on needle tip tracking for infraclavicular blocks did not reveal any significant differences between active needle tip tracking and the control procedures, neither for primary outcome nor secondary outcome measurements.Trial registration numberNCT03631914

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Section: Discussionmentioning

confidence: 99%

“…This might be an indicator for the solid experience levels of the anesthesiologists performing the blocks in our study. 25 …”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic needle tip tracking for in-plane infraclavicular brachialis plexus blocks: a randomized controlled volunteer study

Kåsine

Romundstad

Rosseland

et al. 2020

Reg Anesth Pain Med

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“…The needle was inserted in an in-plane approach, at the six o’ clock location, just inferior to the axillary artery. 14 Aiming at the posterior cord location, two thirds of the drug was deposited at the six o’clock position while the remaining one third was deposited at the nine o’clock position aiming at the lateral cord, during needle retraction.…”

Section: Methodsmentioning

confidence: 99%

Paracoracoid versus Costoclavicular Approach to Infraclavicular Block: A Prospective, Two Arm, Parallel design, Single-centre Randomized Controlled Trial

Brown

Magsaysay

Bureau

et al. 2020

Preprint

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Introduction: Paracoracoid approach to the brachial plexus block is the conventional infraclavicular technique for upper limb surgeries. In this approach, the ultrasound transducer is placed in the parasagittal plane below the clavicle, medial to the coracoid process. In this view, three cords are separated from each other and are rarely visualized in a single ultrasound window. In the costoclavicular approach, the ultrasound transducer is placed parallel to and below the clavicle. In this view, the cords are clustered together, at a more superficial level. We conducted a randomized controlled trial to compare these two infraclavicular brachial plexus approaches. Methods: Seventy patients were randomized to receive either a paracoracoid or costoclavicular infraclavicular block. Both groups received 35 ml of 0.5% ropivacaine under ultrasound guidance. The primary outcome was sensory block onset time while secondary outcomes included performance times, complications during block insertion (paresthesia, vascular puncture, pleural puncture), block failure, patient satisfaction, and postoperative complications. Telephone follow-up was done 24 h and 7 days later. Results: Sensory block onset time was significantly shorter in the paracoracoid group 18.7 (4.4) min versus 22.2 (6.2) min (p=0.045). Block success at 30 minutes was the same between both groups. There was no difference in any secondary outcomes. Conclusion: This randomized controlled trial demonstrated that the novel costoclavicular approach to the infraclavicular brachial plexus block had similar procedure time, block success and similar complication rates for upper limb surgery when compared to the traditional paracoracoid technique but resulted in longer sensory block onset time.

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“…3,4 The need to tailor specific preventive analgesic strategies to patients who will benefit the most is a very relevant topic in perioperative medicine. 1,2…”

Section: Dear Editormentioning

confidence: 99%

Letter Regarding: Prevalence of Neuropathic Pain Symptoms in Foot and Ankle Patients

Cohen¹

2019

Foot Ankle Int.

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I read with great interest the article "Prevalence of Neuropathic Pain Symptoms in Foot and Ankle Patients" by Sidon and colleagues in a recent issue of the journal. 6 The authors performed a cross-sectional study on 533 patients who had foot and ankle surgery and concluded that a considerable number (12.4%) of patients with foot and ankle problems requiring surgery had a neuropathic component of pain. The authors should be applauded for performing a well-designed study in an important topic (eg, pain) in patients undergoing foot and ankle surgery. 3,4 The need to tailor specific preventive analgesic strategies to patients who will benefit the most is a very relevant topic in perioperative medicine. 1,2 Nonetheless, there are some critical points that need to be clarified by the authors to support the validity of their results. First, it is important for the readers to know if all patients received the same postoperative analgesic regimen as this can alter the study results. Certain analgesics (eg, gabapentoids) and nerve blocks have been shown to reduce the development of persistent pain after surgery. 5 Similarly, it is important to know if surgical duration was similar in both groups. Last, given the relatively small sample size, it would be beneficial for the authors to provide the 95% confidence intervals for their estimation. I would welcome comments to address the aforementioned concerns as they were not discussed by the authors. This information would help to further substantiate the findings of this important clinical study.

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Infraclavicular and supraclavicular approaches to brachial plexus for ambulatory elbow surgery: A randomized controlled observer-blinded trial

Cited by 29 publications

References 21 publications

Ultrasonographic needle tip tracking for in-plane infraclavicular brachialis plexus blocks: a randomized controlled volunteer study

Ultrasonographic needle tip tracking for in-plane infraclavicular brachialis plexus blocks: a randomized controlled volunteer study

Paracoracoid versus Costoclavicular Approach to Infraclavicular Block: A Prospective, Two Arm, Parallel design, Single-centre Randomized Controlled Trial

Letter Regarding: Prevalence of Neuropathic Pain Symptoms in Foot and Ankle Patients

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