Comparison of Supraclavicular Regional Nerve Block Versus Infraclavicular Regional Nerve Block in Distal Radial Open Reduction and Internal Fixation: A Retrospective Case Series

Abstract

BackgroundThe management of pain in patients undergoing open reduction and internal fixation (ORIF) of distal radius fractures (DRFs) remains an area of debate for anesthesiologists due to a variety of block options and no definitive superior technique among these modalities. In this retrospective case series, we compare the efficacy of supraclavicular versus infraclavicular regional nerve blocks for surgical patients undergoing distal radial ORIF operations to determine if one approach was superior. MethodologyThis retrospective case series included patients undergoing ORIF of a DRF at a tertiary academic medical center between April 28, 2016, and August 23, 2021. In total, 54 patients undergoing ORIF of a DRF provided written consent for the nerve block(s) on the day of surgery. Of these 54 patients, 54 (100%) underwent primary procedures. Of the 54 primary ORIF patients, 28 (52%) received the supraclavicular block, while 26 (48%) received the infraclavicular nerve block. ResultsThe infraclavicular and supraclavicular groups did not significantly differ regarding age, gender, American Society of Anesthesiologists, weight, or body mass index. The primary (intraoperative opioid use) and secondary (postoperative opioid use, postoperative nausea and vomiting in the post-anesthetic care unit, highest and average pain scores, and time to discharge) outcomes data were included in the study. The infraclavicular and supraclavicular groups did not significantly differ in any of the assessed outcomes except for time to discharge. ConclusionsThe supraclavicular block approach for distal radius ORIF offers an effective and non-inferior alternative to the infraclavicular block approach concerning effective analgesia and safety.

Ultrasound-guided supraclavicular block versus Bier block for emergency reduction of upper limb injuries: a protocol for an open-label, non-inferiority, randomised control trial

“…This will be the rst randomised controlled trial to elucidate the effectiveness and safety of UGSCB compared to BB for the closed reduction of upper limb injuries in the ED. Previous evidence for the e cacy of UGSCB predominantly arise from trials performed by trained anaesthetists in an operating theatre setting [9,10]. Existing evidence from an ED perspective arise from case series [7, and a small prospective study [8].…”

“…A power calculation was performed using previous pain scores reported by Kurkreja et al [9]. Assuming a non-inferiority margin of 2 point difference in the mean VAS pain score (delta), expected standard deviation of ~ 3, alpha 0.025 and a power of 80%, we would require 72 participants in total.…”

“…Evidence supporting the effectiveness of UGSCB has been performed predominantly in the operating theatre by anaesthetists for surgical management of upper limb injuries [9,10]. However, it remains unclear whether UGSCB, when performed by emergency physicians in the ED, is an effective and safe alternative for providing regional anaesthesia for closed reduction of upper limb fractures or dislocations.…”

Ultrasound-guided supraclavicular block versus Bier block for emergency reduction of upper limb injuries: a protocol for an open-label, non-inferiority, randomised controlled trial

“…Sample size calculations were based upon a hypothesis of non-inferiority of UGSCB compared to BB for the primary outcome measure of maximal pain during closed reduction. Sample size calculations were based upon approximation to the normal distribution [ 14 ] using previous pain VAS scores reported by Kukreja et al [ 9 ] and Beck et al [ 15 ]. A non-inferiority margin of 20 mm was selected for power calculation.…”

“…UGSCB has numerous advantages in the ED including familiarity of the anatomy of the supraclavicular region amongst emergency physicians due to ultrasound-guided central venous line placement, its relative ease of being performed, potential for prolonged analgesia and relatively low incidence of complications [ 7 , 8 ]. Evidence supporting the effectiveness of UGSCB has been performed predominantly in the operating theatre by anaesthetists for surgical management of upper limb injuries [ 9 , 10 ]. However, it remains unclear whether UGSCB, when performed by emergency physicians in the ED, is an effective and safe alternative for providing regional anaesthesia for closed reduction of upper limb fractures or dislocations.…”