Selective trunk block (SeTB): a simple alternative to hybrid brachial plexus block techniques for proximal humeral fracture surgery during the COVID-19 pandemic

Sivakumar, Ranjith Kumar; Areeruk, Pornpatra; Karmakar, Manoj K.

doi:10.1136/rapm-2020-101733

Cited by 13 publications

(30 citation statements)

References 6 publications

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“…The development of a new-style approach or needling technique is coming into clinical practice because the advancement in ultrasound guidance allowed for a further understanding of the underlying anatomy of the brachial plexus (trajectory and surrounding fascial sheath) [ 23 ]. For instance, the selective trunk block which is a novel brachial plexus block technique is just inspired by accurately identifying the main components of the plexus above the clavicle under real-time visualization and is expected to result in producing surgical anesthesia of the whole upper extremity [ 24 , 25 ]. Recently, Siddiqui and colleagues [ 12 ] have proposed an alternative approach to the classical approach to a SB, in which LA is carefully injected into the investing adipose layers between the trunks.…”

Section: Discussionmentioning

confidence: 99%

Intertruncal versus classical approach to the ultrasound-guided supraclavicular brachial plexus block for upper extremity surgery: study protocol for a randomized non-inferiority trial

Luo

Cai

Xie

et al. 2022

Trials

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Background Ultrasound-guided intertruncal approach (IA) to the supraclavicular block (SB) is recently proposed as a new approach for local anesthetic (LA) injection in terms of the classical approach (CA) at the level of the first rib. The CA-SB has been proven to result in satisfying sensorimotor block, but associate with a high risk of intraneural injection. The aim of this randomized non-inferiority study is to explore whether IA-SB can obtain similar block dynamics, as the CA-SB, but avoiding an intraneural injection during the whole nerve block procedure. Methods The total 122 patients undergoing elective upper extremity surgery will be randomly allocated to receive either an IA-SB or a CA-SB using a double-injection (DI) technique. In the IA-SB group, a portion of LA (15 mL) is injected accurately to the intertruncal plane between the middle and lower trunks under real-time ultrasound guidance; then, the remaining volume (10 mL) is carefully distributed to the other intertruncal plane between the upper and middle trunks. In the CA-SB group, the DI technique will be carried out as described in Tran’s study. The primary outcome is the percentage of patients with a complete sensory blockade at 20 min with a predefined non-inferiority margin of − 5%. The secondary outcomes include the sensory-motor blockade of all 4 terminal nerves, onset times of the individual nerves within 30 min, block-related variables, and adverse events. Discussion The results will provide sensory-motor blockade-related parameters and safety of the ultrasound-guided intertruncal approach to the supraclavicular block, thereby promoting clinical practice. Trial registration Chinese Clinical Trial Registry ChiCTR2000040199. Registered on 25 November 2020

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Section: Discussionmentioning

confidence: 99%

Intertruncal versus classical approach to the ultrasound-guided supraclavicular brachial plexus block for upper extremity surgery: study protocol for a randomized non-inferiority trial

Luo

Cai

Xie

et al. 2022

Trials

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show abstract

“…Therefore, the combination mode of different approaches should be improved for a more comprehensive brachial plexus block. The hybrid technique of interscalene and supraclavicular approach, interscalene and C8 block, or selective trunks block was recently proposed to completely block the three brachial trunks in PHF surgery (11,(20)(21)(22). However, none of the modes was supported by neither the large cohort of patients nor the randomized controlled trial.…”

Section: Discussionmentioning

confidence: 99%

Is It Useful and Necessary to Add a T2 Paravertebral Block to the Regional Anesthesia During Proximal Humeral Fracture Surgery in Elderly Patients? A Prospective and Randomized Controlled Trial

et al. 2022

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ObjectiveThis study was designed to investigate whether it is useful and necessary to add a T2 level thoracic paravertebral block (TPVB) based on brachial-cervical plexus block to avoid incomplete anesthesia in elderly patients undergoing deltopectoral approach proximal humeral fracture (PHF) surgery.Materials and MethodsThis study involved 80 patients scheduled for PHF surgery who were randomized to receive either IC block (combined interscalene brachial plexus with superficial cervical plexus block) or ICTP block (T2 TPVB supplemented with IC block). The primary outcome was the success rate of regional anesthesia. The patient who experienced incomplete block was administered with intravenous remifentanil for rescue, or conversion to general anesthesia (GA) if remifentanil was still ineffective. Secondary outcomes included requirements of rescue anesthesia, sensory block of the surgical region, the incidence of adverse reactions, and block procedure-related complications.ResultsThe success rate of regional anesthesia in the ICTP group was higher compared with the IC group (77.5 vs. 52.5%, p = 0.019). Intravenous remifentanil was required in 32.5% of patients in the IC group and 17.5% in the ICTP group, respectively. Conversion to GA was performed in 15% of patients in the IC group and 5% in the ICTP group. Sensory block at the medial proximal upper arm was achieved in 85% of patients in the ICTP group, whereas 10% in the IC group (p < 0.001). There was no difference between the groups with respect to the incidence of intraoperative adverse reactions. No block-related complications occurred in either group.ConclusionAdding a T2 TPVB is helpful to decrease, but not absolutely avoid the occurrence of incomplete regional anesthesia during PHF surgery in elderly patients. However, considering the potential risks, it is not an ideal option while a minor dose of remifentanil can provide a satisfactory rescue effect.Clinical Trial RegistrationClinicalTrials.gov, identifier: NCT03919422.

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“…We also observe the puncture-related variables (paresthesia and procedural-related pain), diaphragmatic paralysis, and neurological deficits to evaluating the safety of this TI technique. Therefore, ultrasound-guided IA-SCB with the TI technique has the potential to be as “all for one” technique of the whole upper extremity similar as selective trunk block [ 19 , 20 ], which can provide more complete blockade and rapid onset time with low incidence of adverse events.…”

Section: Discussionmentioning

confidence: 99%

Effects of double vs triple injection on block dynamics for ultrasound-guided intertruncal approach to the supraclavicular brachial plexus block in patients undergoing upper limb arteriovenous access surgery: study protocol for a double-blinded, randomized controlled trial

Luo

Liu

Deng

et al. 2022

Trials

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Background Ultrasound-guided intertruncal approach (IA) has been proposed to be an alternative and promising approach to the supraclavicular block (SCB), in which double injection (DI) of local anesthetics (LA) is sequentially administered between intertruncal planes. We would like to apply a refined injection technique, named triple injection (TI) technique, based on the 3 separate compartments visualized by ultrasound. The aim of this study is to compare the percentage of patients with complete sensory blockade at 20 min of DI vs TI technique, when they are applied in patients undergoing upper limb arteriovenous access surgery. Methods This study is a prospective parallel-group randomized controlled trial. A total of 86 end-stage renal disease patients will be randomly allocated to receive IA-SCB using either DI or TI technique with identical LA (0.5% ropivacaine 24 mL). The primary outcome is the percentage of patients with complete sensory blockade of all 4 terminal nerves (median, ulnar, radial, and musculocutaneous nerves) of the brachial plexus measured at 20 min after injection. The secondary outcomes will consist of the sensory or motor blockade of all individual nerves, onset times, performance time, diaphragmatic paralysis, surgical anesthesia, and adverse events. Discussion It is expected that ultrasound-guided IA-SCB with the TI technique results in better block dynamic in patients undergoing upper limb arteriovenous access surgery. Trial registration Chinese Clinical Trial Registry ChiCTR2100045075.

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Selective trunk block (SeTB): a simple alternative to hybrid brachial plexus block techniques for proximal humeral fracture surgery during the COVID-19 pandemic

Abstract: Contributors RKS was involved with preparation of manuscript and editing the figure. PA was involved with editing the figure and reviewing the manuscript. MKK was involved with editing manuscript.

Cited by 13 publications

References 6 publications

Intertruncal versus classical approach to the ultrasound-guided supraclavicular brachial plexus block for upper extremity surgery: study protocol for a randomized non-inferiority trial

Intertruncal versus classical approach to the ultrasound-guided supraclavicular brachial plexus block for upper extremity surgery: study protocol for a randomized non-inferiority trial

Is It Useful and Necessary to Add a T2 Paravertebral Block to the Regional Anesthesia During Proximal Humeral Fracture Surgery in Elderly Patients? A Prospective and Randomized Controlled Trial

Effects of double vs triple injection on block dynamics for ultrasound-guided intertruncal approach to the supraclavicular brachial plexus block in patients undergoing upper limb arteriovenous access surgery: study protocol for a double-blinded, randomized controlled trial

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