Comparison of Supraclavicular, Infraclavicular, and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Upper Limb Surgeries: A Retrospective Analysis of 182 Blocks

Kılıç, Ebru Tarıkçı; Akdemir, Mehmet Salim

doi:10.1159/000496235

Cited by 4 publications

(4 citation statements)

References 7 publications

(9 reference statements)

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“…In the other subgroup analysis, there was no difference in the duration of nerve blocks administered via axillary or supraclavicular approach. This is in agreement with studies indicating that the approach of brachial plexus block does not affect anesthetic outcomes [ 41 , 42 ].…”

Section: Discussionsupporting

confidence: 92%

Effect of Fentanyl as an Adjuvant to Brachial Plexus Block for Upper Extremity Surgeries: A Systematic Review and Meta-Analysis of RCTs

Song

Tan

Chen

et al. 2022

Pain Research and Management

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Objective. To assess if the addition of fentanyl to brachial plexus block has an impact on anesthetic outcomes and complication rates in patients undergoing upper extremity surgeries. Methods. We explore the PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases for all randomized controlled trials (RCTs) comparing adjuvant fentanyl with placebo/no drug for patients undergoing upper extremity surgery under brachial plexus block. Outcomes assessed were onset, duration of sensory and motor anesthesia, complications, and postoperative analgesia scores. Meta-analysis was conducted utilizing a random-effects model. The risk of bias was assessed using the Cochrane Collaboration’s risk of bias assessment tool 2. Certainty of evidence was assessed using GRADE. Subgroup analysis was conducted depending upon the approach of brachial plexus block and type of local anesthetic. Results. Twelve RCTs with 660 patients were included. Addition of fentanyl had no effect on onset of sensory anesthesia (11 studies; MD: 0.48; 95% CI: −1.81, 0.85; I2 = 96%; p = 0.48 ) but significantly shortened onset of motor anesthesia (8 studies; MD: −2.36; 95% CI: −3.99, −0.74; I2 = 96%; p = 0.48 ). Duration of sensory anesthesia (9 studies; MD: 82.81; 95% CI: 41.81, 123.81; I2 = 99%; p < 0.0001 ) and motor anesthesia (7 studies; MD: 93.41; 95% CI: 42.35, 144.46; I2 = 99%; p = 0.0003 ) was significantly increased with addition of fentanyl. The certainty of evidence-based on GRADE was deemed to be moderate for both onset and duration of anesthesia. The incidence of overall complications (nausea/vomiting and pruritis) was significantly higher in the fentanyl group (7 studies; OR: 2.14; 95% CI: 1.04, 4.40; I2 = 8%; p = 0.04 ) but with low certainty of evidence. Conclusions. Adjuvant fentanyl with brachial plexus block improves the onset of motor anesthesia but not sensory anesthesia. The duration of both sensory and motor anesthesia is significantly prolonged with fentanyl by around 83–93 minutes. However, clinicians should be aware that complications such as nausea/vomiting and pruritis are increased twofold with the addition of the drug. Current evidence is limited risk of bias in the RCTs and high heterogeneity in the meta-analyses.

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Section: Discussionsupporting

confidence: 92%

Effect of Fentanyl as an Adjuvant to Brachial Plexus Block for Upper Extremity Surgeries: A Systematic Review and Meta-Analysis of RCTs

Song

Tan

Chen

et al. 2022

Pain Research and Management

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“…Concerning the block related pain; this study found no statics difference between the groups concerning the discomfort feeling during the block's performance, similar results was found by many previous studies (4,5,8,11) .…”

Section: Discussionsupporting

confidence: 91%

“…Multiple previous studies comparing SC BPB and IC BPB ultrasound guided found that there were no significant differences in performance time (4)(5)(6) . Arcand et al (7) study recorded that although ultrasonic visualization in the infraclavicular block was more rapid than in the supraclavicular region, both blocks had same block performance times, same result was reported by other studies (8-9-10).…”

Section: Discussionmentioning

confidence: 83%

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Supraclavicular Versus Infraclavicular Brachial Plexus Block Using Two Different Techniques: Comparative Study

Abdalziz

Masoud

Balata

et al. 2021

The Egyptian Journal of Hospital Medicine

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Background: A perfectly conducted regional anesthetic guided by ultrasound offers much to anesthesiologists. Objective: This study was aimed to compare supraclavicular block with infraclavicular brachial plexus block for anesthesia in the forearm, hand surgery using two different methods: ultrasound alone or ultrasound together with a nerve stimulator. Patients and Methods: This prospective randomized study was performed on 80 adult patients, aged from 20 to 60 years, with ASA (American Society of Anesthesiology) physical status I and II. Patients were randomized in one of four groups: Supraclavicular block used Ultrasound (n =20), Supraclavicular block used ultrasound with nerve stimulator (n =20), Infraclavicular block used Ultrasound (n =20), Infraclavicular block used ultrasound with nerve stimulator (n =20). The local anesthetic solution used consisted of a 1:1 volume of 0.5 % bupivacaine and 2% lidocaine with 1:200.000 adrenaline. This solution was injected in a dose of 0.5 ml/kg to maximal 40 ml. The Measured parameters were: Demographic values, the scanning time, the block performance time, the onset time, the degree of pain during block performance, evaluation of sensory and motor block, and complications. Result: There were no significant differences between groups as regards all measured parameters. Conclusion: It could be concluded that the supraclavicular nerve block showed no significant difference from infraclavicular ultrasoundguided with or without nerve stimulator. It remains controversial whether the adding of the nerve stimulation to the ultrasound is more beneficial in ensuring rapid onset, longer duration of action, and avoiding complications.

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An alternative to opioid-based intravenous patient controlled analgesia in severe burn patients undergoing full thickness split graft in upper limbs

Shih

Huang

Shen

et al. 2023

JPHS

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Background: Opioids provide good analgesic effect in burn patients during acute phase, but these patients may develop tolerance after prolonged exposure. Alternative analgesic strategies such as peripheral nerve blocks appear to provide adequate pain control while sparing opioid-related side effects. The purpose of this study was to evaluate intravenous patient-controlled analgesia (IV-PCA) and continuous peripheral nerve block (CPNB-PCA) in severe burn patients with relatively young age undergoing repeated debridement and large-area full thickness skin graft (FTSG).Methods: The records of victims in dust explosion in Taiwan in 2016 from Chang Gung Memorial Hospital Pain Service Database between 2016 June and 2017 December were evaluated. The patients’ demographic data including age, gender, weight, burn area, degree of burn, type of PCA regimen (IV-PCA versus CPNB-PCA), size of FTSG, and adverse effects were collected. Results: The total in-hospital morphine consumption was significantly lower in CPNB-PCA than IV-PCA group. A trend of decrease in numerical rating scores (NRS) was observed for both groups and CPNB group had comparable NRS than IV-PCA group at rest. On movement, CPNB grouped had significantly lower NRS than IV-PCA on post-operative day 3.Conclusion: Our study demonstrated that in patients requiring high dosage of opioid, CPNB may be a suitable alternative for pain control.

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Comparison of Supraclavicular, Infraclavicular, and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Upper Limb Surgeries: A Retrospective Analysis of 182 Blocks

Cited by 4 publications

References 7 publications

Effect of Fentanyl as an Adjuvant to Brachial Plexus Block for Upper Extremity Surgeries: A Systematic Review and Meta-Analysis of RCTs

Effect of Fentanyl as an Adjuvant to Brachial Plexus Block for Upper Extremity Surgeries: A Systematic Review and Meta-Analysis of RCTs

Supraclavicular Versus Infraclavicular Brachial Plexus Block Using Two Different Techniques: Comparative Study

An alternative to opioid-based intravenous patient controlled analgesia in severe burn patients undergoing full thickness split graft in upper limbs

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