Comparison of Ultrasound Guided Interscalene and Supraclavicular Brachial Plexus Block for Clavicle Fracture Surgery

Abstract

Introduction:The clavicle has dual nerve supply from the brachial plexus and cervical plexus. The interscalene brachial plexus block combined with superior cervical plexus block is frequently used for the clavicle surgery. This study was conducted to compare ineterscalene approach with the supraclavicular approach for brachial plexus block used for clavicle surgery Methodology:This was prospective comparative study conducted for two years in tertiary care hospital. Sixty patients with clavicle fracture with ASA I and II were randomly divided into two equal groups; ISBPB (interscalene approach) and SCBPB (supraclavicular approach). Both of these blocks were combined with superior cervical plexus block. Ultrasound was used to perform all the blocks. Primary outcome for the comparison was block characteristics, which included sensory and motor block onset, duration, and block satisfaction. The secondary variables used for comparison were analgesic properties and complications. Results: Supraclavicular brachial plexus had rapid onset of sensory and motor block and was statistically significant (P<0.05) as compared to interscalene approach. Similarly, SCBPB had significantly longer duration of sensory block (P=0.003). The duration of motor block was comparable between the blocks. The intraoperative pain score (VAS), requirement of rescue analgesia with in 24 hours of surgery and complications related with the procedures were comparable between the two groups. Majority of the patients were satisfied with either of the approach for brachial plexus block. Conclusion: Supraclavicular brachial plexus block combined with superior cervical plexus block provided equally effective and adequate anesthesia and analgesia for clavicle surgery with comparable complications as compared to interscalene approach.

Regional Anesthetic and Analgesic Techniques for Clavicle Fractures and Clavicle Surgeries: Part 1—A Scoping Review

“…Following a thorough review of the titles, abstracts, full-text, and reference lists, we included and extracted data from a total of 44 studies and/or reports containing patient data, spanning a total of 3161 patients with clavicular fractures who received some form of regional anesthesia and analgesia. We excluded one retracted article and its retraction note from the final list of 44 studies [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. There were 5 RCTs, 5 prospective observational studies, 5 retrospective observational studies, and 29 case reports/case series included in this scoping review ( Figure 1 and Table 2 ).…”

“…Most studies purportedly, in-text, included a SCPB (28 articles). However, considering the nomenclature differences above, we contend that at least 14 of these studies described an ICPB, while 5 studies performed a SCPB ( Table 3 ) [ 7 , 8 , 13 , 15 , 21 , 23 , 25 , 28 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 42 , 43 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 59 , 60 ]. Taking the in-text description at face value, two articles seemed to describe a deep cervical plexus block with deposition of LA below the prevertebral fascia, while the remaining eight studies did not provide sufficient detail to classify the block [ 8 , 15 , 28 , 33 , 34 , 36 , 37 , 48 , 60 ].…”

“…Cervical plexus blockade was also commonly used in combination with another nerve or fascial plane block. The most common combined technique utilized cervical plexus blockade with an ISB, as reported in 18 studies [ 7 , 8 , 13 , 21 , 23 , 25 , 32 , 36 , 37 , 38 , 39 , 43 , 45 , 46 , 48 , 51 , 52 , 53 ]. Of these, five studies utilized a SCPB, and nine studies described an ICPB [ 7 , 13 , 21 , 23 , 25 , 32 , 38 , 39 , 45 , 46 , 48 , 51 , 52 , 53 ].…”

“…The interscalene approach to the brachial plexus was the next most common technique, as described in 21 studies [ 7 , 8 , 13 , 21 , 23 , 24 , 25 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 43 , 45 , 46 , 48 , 51 , 52 , 53 ]. The supraclavicular approach to the brachial plexus was described only in a case report and a prospective randomized study, and in both cases this was combined with an ICPB [ 32 , 43 ].…”

“…Ryan et al (52 cases), Fugelli et al (10 cases), Balaban et al (10 cases), Contractor et al (30 cases), and Reverdy et al (12 cases) have all described 100% success in providing surgical anesthesia by combining either a SCPB or ICPB with an ISB ( Table 2 and Table 3 ), as have a few small case series and case reports [ 7 , 24 , 25 , 32 , 38 , 39 , 45 , 46 , 48 , 51 ]. Three small studies reported a low block failure rate requiring conversion to GA (3 to 6%) with this combination; however, the lack of technical detail makes it difficult to provide insight if this might be associated with the level of cervical plexus blockade [ 8 , 37 , 43 ]. An RCT (60 cases) by Neha Gupta et al ( Table 2 and Table 3 ) compared combined cervical plexus blockade with ISB versus ISB alone as surgical anesthesia for clavicle surgery under sedation.…”