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

Abstract

Background. Distal arm surgery is widely performed under regional anesthesia with brachial plexus block. The preponderance of evidence for the efficacy relies upon injection of local anesthetic in excess of 30 mL. We aimed to compare three different ultrasound-guided brachial plexus block techniques restricting the total volume to 20 mL. Methods. 120 patients were prospectively randomized to ultrasound-guided brachial plexus block with 20 mL ropivacaine 0.75% at either the supraclavicular, infraclavicular, or axillary level. Multiinjection technique was performed with all three approaches. Primary outcome measure was performance time. Results. Performance time and procedural pain were similar between groups. Needle passes and injection numbers were significantly reduced in the infraclavicular group (P < 0.01). Nerve visibility was significantly reduced in the axillary group (P = 0.01). Success-rate was significantly increased in the supraclavicular versus the axillary group (P < 0.025). Total anesthesia-related time was significantly reduced in the supraclavicular compared to the infraclavicular group (P < 0.01). Block duration was significantly increased in the infraclavicular group (P < 0.05). No early adverse effects occurred. Conclusion. Supraclavicular and infraclavicular blocks exhibited favorable characteristics compared to the axillary block. Supraclavicular brachial plexus block with the multiinjection intracluster technique exhibited significantly reduced total anesthesia-related time and higher success rate without any early adverse events.

Ultrasound Guided Axillary Brachial Plexus Block Versus Supraclavicular Block In Emergency Crushed Hand Patients : A Comparative Study

“…In relation to performance time, longer anesthesia-related time was noticed in AXB when compared to SCB, the same was reported by Anatoli et al [3]. Arnuntasupakul et al and Vazin et al also found that SCB resulted in shorter anaesthesia related time which coincides with our results [11,14].…”

“…However, Vazin et al in a study comparing axillary versus supraclavicular block for distal arm surgery concluded that supraclavicular block had a higher success rate than the axillary block [14], which doesn't match the results we reached, and this may be attributed to the multiple injection techniques they used for supraclavicular block while we performed the block through a single injection site.…”

Fascial layers influence the spread of injectate during ultrasound-guided infraclavicular brachial plexus block: a cadaver study

“…The success rate with multiple injections is high even with volumes as low as 16e20 ml. 13,14 A single injection technique appears to require greater volumes of injectate: Arcand and colleagues 2 had 80% success rate with 40 ml of LA; Flohr-Madsen and colleagues 15 found MEV50 to be 19 ml with a periarterial injection from 1 to 9 o'clock. Our success rate with 20 ml of dye delivered as a single injection is similar to that reported by Flohr-Madsen and colleagues.…”

Effect of a lateral infraclavicular brachial plexus block on the axillary and suprascapular nerves as determined by electromyography – a cohort study

“…To our knowledge, this is the first study that used surface electromyography to quantify the block of individual nerves after an infraclavicular brachial plexus block. Several studies have reported the effect of an infraclavicular brachial plexus block on the axillary nerve using different variations of simple sensory and motor tests, but only as secondary outcomes and results are conflicting, with rates ranging from 9% to 100% .…”