A Comparison Between Ultrasound-Guided Supraclavicular and Infraclavicular Approaches to Brachial Plexus Block for Elective Upper Limb Surgery

Abstract

Background: Regional anaesthesia offers the anaesthesiologist, the surgeon, as well as the patient advantages over general anaesthesia such as being conscious through the surgery, avoiding multiple drugs, better haemodynamic stability, excellent postoperative analgesia, and faster per oral consumption post surgery. Compared with the axillary approach, the brachial plexus block at the level of the clavicle can anaesthetize all four distal upper extremity nerve territories without the requirement for a separate block of the musculocutaneous nerve. Aim: The aim of the study was to compare the effect of both supraclavicular and infraclavicular brachial plexus blocks in terms of time taken for onset, performance, and block success. Materials and methods: Sixty patients undergoing below-elbow upper limb surgeries were randomized into two groups: (i) supraclavicular (Group S) and (ii) infraclavicular (Group I). All patients received 30ml 0f 0.5% bupivacaine as the local anesthetic of choice. The block performance time, time taken for onset of sensory and motor blockade, total duration of block, and hemodynamic parameters were observed. The block performance times and the onset of the sensory blockade were the primary outcomes while the duration of the block and hemodynamic parameters were secondary outcomes. Two two-tailed independent sample t-tests will be used to compare the variables. Results: We observed that the block performance time for the infraclavicular block (mean 14.833 minutes) was longer than the supraclavicular block (mean 10.37 minutes). This was statistically significant with p <0.001. In terms of onset of sensory blockade, the infraclavicular group (13.667 minutes) had a quicker onset compared to the supraclavicular group (17.333 minutes). This was also statistically significant with p <0.001. The mean total duration of sensory and motor blockade was similar in both groups (p-value of 0.341 and 0.791 respectively) and there was no statistical difference. There was no hemodynamic instability or complications in our study. Conclusion: Ultrasound-guided infraclavicular block is a relatively safer technique when compared to the supraclavicular technique with faster onset. The time taken for administering the infraclavicular block can be reduced by repeated exposure to the technique.