Avaliação do envolvimento dos fascículos do plexo braquial no bloqueio por via infraclavicular: estudo em cadáveres não fixados

Gusmão, Luiz Carlos Buarque de; Lima, Jacqueline Silva Brito; Ramalho, Jeane da Rosa Oiticica; Leite, Amanda Lira dos Santos; Silva, Alberson Maylson Ramos da

doi:10.1016/j.bjan.2014.06.003

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…Because a steep-angle needle-ultrasound (US) beam is often required, needle visualization remains a challenge in coracoid ICB, particularly when the needle approaches the neurovascular bundle [8, 9]. Because the needle entry point is different, the recently described retroclavicular (RCB) approach offers an almost perpendicular angle between needle and the US beam [10].…”

Section: Introductionmentioning

confidence: 99%

Retroclavicular approach vs infraclavicular approach for plexic bloc anesthesia of the upper limb: study protocol randomized controlled trial

Langlois

Gil-Blanco

Jessop³

et al. 2017

Trials

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BackgroundThe coracoid approach is recognized as the simplest approach to perform brachial plexus anaesthesia, but needle visualization needs to be improved. With a different needle entry point, the retroclavicular approach confers a perpendicular angle between the ultrasound and the needle, which theoretically enhances needle visualization. This trial compares these two techniques. The leading hypothesis is that the retroclavicular approach is comparable to the infraclavicular coracoid approach in general aspects, but needle visualization is better with this novel approach.MethodsWe designed a multicentre, randomized, non-inferiority trial. Patients eligible for the study are older than 18 years, able to consent, will undergo urgent or elective upper limb surgery distal to the elbow and are classified with American Society of Anaesthesiologists risk score (ASA) I-III. They will be excluded if they meet contraindicated criteria to regional anaesthesia, have affected anatomy of the clavicle or are pregnant. Randomization will be done by a computer-generated randomization schedule stratified for each site and in 1:1 ratio, and concealment will be maintained with opaque, sealed envelopes in a locked office. The primary outcome, the performance time, will be analyzed using non-inferiority analysis while secondary outcomes will be analyzed with superiority analysis. Needle visualization will be ranked on a Likert scale of 1–5 that is subjective and represents a pitfall. Two separate persons will rank needle visualization to compensate this pitfall. According to previous studies, 49 patients per group are required for statistical power of 0.90 and one-sided type I error of 0.05.DiscussionThe conduct of this study will bring clear answers to our questions and, if our hypothesis is confirmed, will confer an anatomic alternative to difficult coracoid infraclavicular brachial blocks or could even become a standard for brachial plexus anaesthesia.Trial registrationClinicalTrials.gov, NCT02913625. Registered on 12 September 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2086-1) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Retroclavicular approach vs infraclavicular approach for plexic bloc anesthesia of the upper limb: study protocol randomized controlled trial

Langlois

Gil-Blanco

Jessop³

et al. 2017

Trials

View full text Add to dashboard Cite

show abstract

“…The infraclavicular (ICB) (coracoid) approach for brachial plexus anesthesia is recognized for its facility and simplicity to perform. However, an inevitable pitfall of this method is the steep angle between the needle and the ultrasound probe that makes needle visibility challenging [3–8]. Because of its different needle entry point, the retroclavicular (RCB) approach [9] offers an almost perpendicular needle-ultrasound (US) beam angle, but aims at the same goal as the ICB.…”

Section: Introductionmentioning

confidence: 99%

Retroclavicular vs Infraclavicular block for brachial plexus anesthesia: a multi-centric randomized trial

Blanco

Laferrière-Langlois

Jessop³

et al. 2019

BMC Anesthesiol

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BackgroundThe 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.MethodsThis 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.ResultsWe 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.ConclusionRCB 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 registrationClinicalTrials.gov (NCT02913625), registered 26 September 2016.

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Avaliação do envolvimento dos fascículos do plexo braquial no bloqueio por via infraclavicular: estudo em cadáveres não fixados

Cited by 2 publications

References 7 publications

Retroclavicular approach vs infraclavicular approach for plexic bloc anesthesia of the upper limb: study protocol randomized controlled trial

Retroclavicular approach vs infraclavicular approach for plexic bloc anesthesia of the upper limb: study protocol randomized controlled trial

Retroclavicular vs Infraclavicular block for brachial plexus anesthesia: a multi-centric randomized trial

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