Infraclavicular Brachial Plexus Block Versus Humeral Block in Trauma Patients: A Comparison of Patient Comfort

Abstract

In this prospective randomized study, we compared humeral block (HB) and infraclavicular brachial plexus block (ICB) with pain caused by the block as a primary outcome, assuming that ICB would cause less pain than HB. Patients undergoing emergency upper limb surgery were included in this study and received either ICB (group I, n = 52 patients) or HB (group H, n = 52 patients). Patients were asked to quantify the severity of the pain during the procedure using a visual analog scale from 0 to 100 mm and to identify which of the 4 components of the procedure was most unpleasant (skin transfixion, needle redirection in search of the nerves, local anesthetic injections, or electrical stimulation). The block was assessed every 5 min for 30 min after completion of the block. Overall visual analog scale scores for the block were 35 +/- 27 mm in group H versus 19 +/- 18 mm in group I (P < 0.0011). Electrical stimulation was the most unpleasant part of the block (group H, 29 +/- 15 mm versus group I, 15 +/- 10 mm) (P < 0.019). Time to perform the block was significantly shorter in group I (ICB, 6 +/- 4 min versus HB, 10 +/- 4 min; P < 0.0001). The onset time was 13 +/- 7 min for ICB and 9 +/- 3 min for HB (P < 0.05). No serious complications were observed. In summary, ICB is less painful, compared with HB, with a similar success rate.

Eutectic Mixture of Local Anesthetic (EMLA®) Decreases Pain During Humeral Block Placement in Nonsedated Patients

“…Only recently has pain related to skin puncture been specifically studied (7). In fact, previous studies sought to identify the most painful step in the block without considering the pain associated with needle punctures (4 -6).…”

“…Before the study, the necessary sample size was estimated according to the results of previous studies (10,11) and our own recent study comparing humeral and infraclavicular blocks (7). We hypothesized that the pain of skin puncture estimated by VAS would be decreased by 50% after EMLA application compared with that after placebo and sufentanil administration.…”

“…Previous studies have evaluated the potentially painful steps involved in regional anesthesia (RA) techniques (i.e., neurostimulation, repeated needle punctures, etc.) none has focused specifically on skin puncture (4 -6), a known source of pain in humeral block (7).…”

Upper Extremity Blocks

“…67,68 Infraclavicular block techniques have the advantage of not requiring a specific arm position during placement, which is useful for patients with limited arm motion because of pain, casts, or dressings. 69 The infraclavicular approach is frequently used for continuous perineural catheter placement because the catheters reliably remain in place during use. There have been reports of successful use of continuous infraclavicular perineural infusion for the treatment of complex regional pain syndrome of the upper extremity 70 …”

Importance of Anatomical Landmarks on Axillary Neurovascular Territories for Surgery

“…Some damages, such as those correlated with uncommon variations, may not be preventable. However, many if not most cases are preventable by the way of a detailed anatomical knowledge on axillary region and displaying of situations in which peripheral nerves are primarily under risk (Zhang et al, 2011;Minville et al, 2006).…”