Retroclavicular approach to infraclavicular brachial plexus block: a logical conundrum

Leurcharusmee, Prangmalee; Layera, Sebastián; Finlayson, Roderick J.; Tran, De Q.H.

doi:10.1136/rapm-2018-100133

“…Our clinical experience leads us to infer that if the supraclavicular fossa is palpable and depressible, RCB is likely to be feasible even with high BMI patients, until an arterial depth of 5 cm is reached. In a time where there is increased interest, controversies and discussion about the RCB method (19)(20)(21)(22), our study represents one of the first that properly compare these two methods and confirms its safety and efficacy.…”

Section: Discussionmentioning

confidence: 62%

Retroclavicular vs Infraclavicular block For Brachial Plexus Anesthesia: A Multi-Centric Randomized Trial

Blanco

¹

,

Laferrière-Langlois

²

,

Jessop

³

et al. 2019

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0

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Background: The coracoid approach is a simple method to perform ultrasound-guided brachial plexus regional anesthesia (RA) but its simplicity is counterbalanced by a difficult needle visualization. We hypothesized that the retroclavicular (RCB) approach is not longer to perform when compared to the coracoid (ICB) approach, and improves needle visualization. Methods: This randomized, controlled, non-inferiority trial conducted in two hospitals, included patients undergoing distal upper limb surgery. Patients were randomly assigned to a brachial plexus block (ICB or RCB). The primary outcome was performance time (sum of visualization and needling time), and was analyzed with a non-inferiority test of averages. Depth of sensory and motor blockade, surgical success, total anesthesia time, needle visualization, number of needle passes and complications were also evaluated. Subgroup analysis restricted to patients with higher body mass index was completed. Results: We included 109 patients between September 2016 and May 2017. Mean RCB performance time was 4.8 ± 2.0 min while ICB was 5.2 ± 2.3 min (p=0.06) with a 95% CI reaching up to 5.8% longer. RCB conferred an ultrasound-needle angle closer to 0° and significantly improved needle visibility after the clavicle was cleared and before local anesthetic administration. No differences were found in the secondary outcomes. Similar results were found in the subgroup analysis. Conclusion: RCB approach for brachial plexus anesthesia was similar to ICB approach in terms of time performance. Needle visibility, which represent an important clinical variable, was superior and angle between needle and ultrasound probe was close to 0° in the RCB group. Clinical Trial Registration: ClinicalTrials.gov (NCT02913625), registered 26 September 2016.

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“…The high BMI subgroup analysis also suggests that needle visibility and needle angle improvements with RCB over ICB are still present and not affected by higher BMI. In a time where there is increased interest, controversies and discussion about the RCB method (19)(20)(21)(22), our study represents one of the first that properly compare these two methods and confirms its safety and efficacy.…”

Section: Discussionmentioning

confidence: 62%

Retroclavicular vs Infraclavicular block For Upper Limb Anesthesia: A Multi-Centric Randomized Trial

Afg

¹

,

Laferrière-Langlois

²

,

Jessop

³

et al. 2019

Preprint

0

View full text Add to dashboard Cite

Background: The coracoid approach is a simple method to perform ultrasound-guided brachial plexus regional anesthesia (RA) but its simplicity is counterbalanced by a difficult needle visualization. We hypothesized that the retroclavicular (RCB) approach is not longer to perform when compared to the coracoid (ICB) approach, and improves needle visualization. Methods: This randomized, controlled, non-inferiority trail conducted in two hospitals, included patients undergoing distal upper limb surgery. Patients were randomly assigned to a brachial plexus block (ICB or RCB). The primary outcome was performance time (sum of visualization and needling time), and was analyzed with a non-inferiority test of averages. Depth of sensory and motor blockade, surgical success, total anesthesia time, needle visualization, number of needle passes and complications were also evaluated. Subgroup analysis restricted to patients with higher body mass index was completed. Results: We included 109 patients between September 2016 and May 2017. Mean RCB performance time was 7.1% shorter than ICB (retro: 4.8 ± 2.0 min; infra: 5.2 ± 2.3 min, p=0.06) with a 95% CI reaching up to 5.8% longer. RCB conferred an ultrasound-needle angle closer to 0° and significantly improved needle visibility after the clavicle was cleared and before local anesthetic administration. No differences were found in the secondary outcomes. Similar results were found in the subgroup analysis. Conclusion: In patients undergoing distal upper limb surgery with an infraclavicular anesthesia, performance time with RCB approach was deemed clinically similar to ICB approach while improving needle visibility. Clinical Trial Registration: ClinicalTrials.gov (NCT02913625), registered 26 September 2016

show abstract

“…Our clinical experience leads us to infer that if the supraclavicular fossa is palpable and depressible, RCB is likely to be feasible even with high BMI patients, until an arterial depth of 5 cm is reached. In a time where there is increased interest, controversies and discussion about the RCB method (19)(20)(21)(22), our study represents one of the first that properly compare these two methods and confirms its safety and efficacy.…”

Section: Discussionmentioning

confidence: 66%

Retroclavicular vs Infraclavicular block For Brachial Plexus Anesthesia: A Multi-Centric Randomized Trial

Blanco

¹

,

Laferrière-Langlois

²

,

Jessop

³

et al. 2019

Preprint

0

View full text Add to dashboard Cite

Background: The coracoid approach is a simple method to perform ultrasound-guided brachial plexus regional anesthesia (RA) but its simplicity is counterbalanced by a difficult needle visualization. We hypothesized that the retroclavicular (RCB) approach is not longer to perform when compared to the coracoid (ICB) approach, and improves needle visualization. Methods: This randomized, controlled, non-inferiority trial conducted in two hospitals, included patients undergoing distal upper limb surgery. Patients were randomly assigned to a brachial plexus block (ICB or RCB). The primary outcome was performance time (sum of visualization and needling time), and was analyzed with a non-inferiority test of averages. Depth of sensory and motor blockade, surgical success, total anesthesia time, needle visualization, number of needle passes and complications were also evaluated. Subgroup analysis restricted to patients with higher body mass index was completed. Results: We included 109 patients between September 2016 and May 2017. Mean RCB performance time was 4.8 ± 2.0 min while ICB was 5.2 ± 2.3 min (p=0.06) with a 95% CI reaching up to 5.8% longer. RCB conferred an ultrasound-needle angle closer to 0° and significantly improved needle visibility after the clavicle was cleared and before local anesthetic administration. No differences were found in the secondary outcomes. Similar results were found in the subgroup analysis. Conclusion: RCB approach for brachial plexus anesthesia was similar to ICB approach in terms of time performance. Needle visibility, which represent an important clinical variable, was superior and angle between needle and ultrasound probe was close to 0° in the RCB group. Clinical Trial Registration: ClinicalTrials.gov (NCT02913625), registered 26 September 2016.

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Retroclavicular approach to infraclavicular brachial plexus block: a logical conundrum

Cited by 7 publications

References 13 publications

Retroclavicular vs Infraclavicular block For Brachial Plexus Anesthesia: A Multi-Centric Randomized Trial

Retroclavicular vs Infraclavicular block For Brachial Plexus Anesthesia: A Multi-Centric Randomized Trial

Retroclavicular vs Infraclavicular block For Upper Limb Anesthesia: A Multi-Centric Randomized Trial

Retroclavicular vs Infraclavicular block For Brachial Plexus Anesthesia: A Multi-Centric Randomized Trial

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