Comparison of para-vascular supraclavicular brachial plexus block and costo-clavicular approach of infraclavicular brachial plexus block in providing surgical anesthesia for below elbow surgery: a randomized, single blind study

Abstract

Abstract Background With better precision of the brachial plexus block (BPB) under real-time ultrasound guidance, supraclavicular BPB (SC-BPB) and infraclavicular BPB (IC-BPB) are being used interchangeably for upper limb surgeries. However, the number of anesthesiologists practicing SC-BPB is much more than those practicing IC-BPB. Many studies have compared SC-BPB and IC-BPB, but a study comparing the para-vascular approach of SC-BPB and costo-clavicular approach of IC-BPB is missing. This prospective study compared the costo-clavicular approach of IC-BPB with the para-vascular approach of SC-BPB. A total of 80 patients (40 in each group), aged 18–65 years, belonging to ASA class I and II and undergoing hand, wrist and forearm surgery were randomly allocated to group S (receiving SC-BPB) and group I (receiving IC-BPB). The two groups were compared with respect to the block success rate, block performance time, time taken to achieve surgical anesthesia, efficacy, and safety in providing surgical anesthesia for below elbow upper limb surgeries. Results Block success was significantly higher in the IC-BPB (100%) vs SC-BPB (92.5%), P value 0.03. Scan time was significantly more in the SC-BPB, P value 0.001. The block performance time was comparable; time to achieve surgical anesthesia was significantly longer in the IC-BPB, P value 0.001. Time for first rescue analgesia was longer in the IC-BPB, P value 0. 001. The number of patients requiring intraoperative sedation was comparable, P value 0.99. Conclusions IC-BPB has greater success rate in providing surgical anesthesia in below elbow surgeries and provides longer postoperative analgesia.

Keywords

• Brachial plexus block
• Upper extremity
• Analgesia
• Anesthesia