Infraclavicular brachial plexus block in adults: a comprehensive review based on a unified nomenclature system

Hsu, An-Chih; Tai, Yu‐Ting; Lin, Ko-Huan; Yao, Han-Yun; Chiang, Han-Liang; Ho, Bing‐Ying; Yang, Sheng-Feng; Lin, Jui-An; Ko, Ching-Lung

doi:10.1007/s00540-019-02638-0

Cited by 15 publications

(10 citation statements)

References 74 publications

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“…Numerous modifications have been described, and it is impossible to cover each one in this paper. The different approaches can be broadly classified into proximal or distal with regard to at the axillary artery, that is, “proximal ICPB” if the local anesthetic is injected at its first portion and “distal ICPB” for the injection at its second portion (and further) ( 34 ). Examples of proximal ICPB include vertical proximal approach as described by Kilka et al ( 35 ), lateral proximal approach (lateral-to-medial needle direction) as described by Li et al ( 36 ) (costoclavicular approach) and Yoshida et al ( 37 ), and medial proximal approach (medial-to-lateral needle direction) by Nieuwveld et al (medial approach) ( 38 ).…”

Section: Infraclavicular Blockmentioning

confidence: 99%

Supraclavicular vs. Infraclavicular Brachial Plexus Nerve Blocks: Clinical, Pharmacological, and Anatomical Considerations

et al. 2021

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: Peripheral nerve blocks (PNB) have become standard of care for enhanced recovery pathways after surgery. For brachial plexus delivery of anesthesia, both supraclavicular (SC) and infraclavicular (IC) approaches have been shown to require less supplemental anesthesia, are performed more rapidly, have quicker onset time, and have lower rates of complications than other approaches (axillary, interscalene, etc.). Ultrasound-guidance is commonly utilized to improve outcomes, limit the need for deep sedation or general anesthesia, and reduce procedural complications. Given the SC and IC approaches are the most common approaches for brachial plexus blocks, the differences between the two have been critically evaluated in the present manuscript. Various studies have demonstrated slight favorability towards the IC approach from the standpoint of complications and safety. Two prospective RCTs found a higher incidence of complications in the SC approach – particularly Horner syndrome. The IC method appears to support a greater block distribution as well. Overall, both SC and IC brachial plexus nerve block approaches are the most effective and safe approaches, particularly under ultrasound-guidance. Given the success of the supraclavicular and infraclavicular blocks, these techniques are an important skill set for the anesthesiologist for intraoperative anesthesia and postoperative analgesia.

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Section: Infraclavicular Blockmentioning

confidence: 99%

Supraclavicular vs. Infraclavicular Brachial Plexus Nerve Blocks: Clinical, Pharmacological, and Anatomical Considerations

et al. 2021

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“…Comparison of ultrasound-guided costoclavicular and supraclavicular brachial plexus block for upper extremity surgery: a propensity score matched retrospective cohort study Both ultrasound-guided SC-BPB and IC-BPB show a high success rate and fast block onset time (4)(5)(6). A systematic review involving 10 studies found a statistically higher incidence of incomplete sensory block within 30 minutes in an IC-BPB group compared with a SC-BPB group, although no differences were found in success rate, block onset time, and analgesia duration (7).…”

Section: Original Articlementioning

confidence: 99%

Comparison of ultrasound-guided costoclavicular and supraclavicular brachial plexus block for upper extremity surgery: a propensity score matched retrospective cohort study

2021

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Background: Ultrasound-guided costoclavicular (CC) brachial plexus blocks (BPBs) are a novel approach for nerve block in upper extremity surgery. However, comparisons between CC-BPB and conventional supraclavicular (SC) BPB have not clearly delineated the benefits or costs of either method.Methods: This retrospective cohort study enrolled patients receiving BPB due to upper extremity fracture between June 2019 and May 2020. Data were collected from the medical records of patients, including age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status, side of block, and operative location. Enrolled patients were matched in a 1:2 ratio using propensity score matching models. The primary outcomes in this study were the proportions of complete sensory and motor blocks and the secondary outcomes included other block-related outcomes, pain-related outcomes, and side effects or complications. Results:The study enrolled 235 patients with upper extremity fracture and there was a significant difference in the side of block when comparing ultrasound-guided CC-BPB and SC-BPB. After propensity score matching, 62 patients receiving ultrasound-guided CC-BPB and 124 receiving ultrasound-guided SC-BPB were enrolled. The proportions of complete sensory and motor block at each interval after injection showed no significant difference when the groups were compared. Although CC-BPB involved a longer procedure time than SC-BPB (6.2±0.7 vs. 5.1±0.5 min, P<0.001), it provided a longer duration of nerve block (duration of sensory block: 468.2±103.5 vs. 396.5±83.4 min, P<0.001; duration of motor block: 554.6±99.5 vs. 469.7±96.0 min, P<0.001). Patients with Horner's syndrome were also more prevalent in the SC-BCB group (n=11) (8.9%) in comparison to one patient (1.6%) in CC-BPB group (P=0.04).Conclusions: CC-BPB is a safe and efficient approach for upper extremity surgery.

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“…The ultrasound (US)-guided infraclavicular block (ICB) is commonly used to provide anesthesia and analgesia in the arm, elbow, forearm, and hand surgeries. The ICB blocks the brachial plexus at the level of the cords [1,2], and a lateral sagittal (LS) approach is usually preferred for this block. In the LS approach, the block needle is placed in the lateral infraclavicular fossa in the parasagittal plane, and a local anesthetic (LA) is injected around the second part of the axillary artery.…”

Section: Introductionmentioning

confidence: 99%

“…In the LS approach, the block needle is placed in the lateral infraclavicular fossa in the parasagittal plane, and a local anesthetic (LA) is injected around the second part of the axillary artery. Despite being a safe and effective technique, the LS approach may require multiple injections and the use of relatively large volumes of LA, since the cords are located deeply and separately from each other and have many anatomical variations [1,3,4].…”

Section: Introductionmentioning

confidence: 99%

Lateral Sagittal Versus Costoclavicular Approaches for Ultrasound-Guided Infraclavicular Brachial Plexus Block: A Comparison of Block Dynamics Through A Randomized Clinical Trial

Dost¹,

Kaya²,

Üstün³

et al. 2021

Cureus

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In this study, our objective was to compare the lateral sagittal infraclavicular block (LS-ICB) with the costoclavicular infraclavicular block (CC-ICB) for ultrasound (US)-guided infraclavicular brachial plexus block in terms of block dynamics as well as patient and surgeon satisfaction levels. MethodsA total of 100 patients, falling under the American Society of Anaesthesiologists (ASA) I-III categories, who were aged 18-65 years and scheduled for elective forearm and hand surgery were enrolled in the study. The patients were randomly allocated to receive a US-guided LS-ICB or US-guided CC-ICB. The local anesthetic (LA) agent used (20-ml 0.5% bupivacaine) was identical in all subjects. The block performance time and the motor and sensory block onset times were determined to be the primary outcomes. ResultsThe block performance time and the sensory block onset time were shorter in the CC-ICB group compared to the LS-ICB group [median (interquartile range): three (2.5-3.3) vs. two (1.5-2.3) minutes, p: <0.001; five (4.4-6) vs. four (3.8-6) minutes, p = 0.022, respectively]. The number of needle redirections was lower in the CC-ICB [three (2.7-4) vs. two (one to two) times, p: <0.001]. The motor block onset time and the motor-sensory block times were similar in both groups. There were more patients with a complete sensory blockade at five and 10 minutes in the CC-ICB group than in the LS-ICB group (30% vs. 12%, p = 0.027; 66% vs. 26%, p: <0.001, respectively). No complications were observed with regard to both techniques, and patient and surgeon satisfaction levels observed were similar for both groups. ConclusionBased on our findings, the CC approach provided a shorter performance time and a faster onset of the sensory block compared to the LS approach. However, no complications were reported with respect to either technique, and similar patient and surgeon satisfaction levels were observed.

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Infraclavicular brachial plexus block in adults: a comprehensive review based on a unified nomenclature system

Cited by 15 publications

References 74 publications

Supraclavicular vs. Infraclavicular Brachial Plexus Nerve Blocks: Clinical, Pharmacological, and Anatomical Considerations

Supraclavicular vs. Infraclavicular Brachial Plexus Nerve Blocks: Clinical, Pharmacological, and Anatomical Considerations

Comparison of ultrasound-guided costoclavicular and supraclavicular brachial plexus block for upper extremity surgery: a propensity score matched retrospective cohort study

Lateral Sagittal Versus Costoclavicular Approaches for Ultrasound-Guided Infraclavicular Brachial Plexus Block: A Comparison of Block Dynamics Through A Randomized Clinical Trial

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