Infraclavicular versus supraclavicular nerve block for upper limb surgeries: A meta-analysis

Abstract

Background: The impact of infraclavicular versus supraclavicular nerve block on the analgesia for upper limb surgeries is unclear. This meta-analysis and systematic review aims to study the analgesic efficacy of infraclavicular versus supraclavicular nerve block for upper limb surgeries. Methods: We searched several databases including PubMed, EMbase, Web of science, EBSCO and Cochrane library databases from inception to December 2023, and randomized controlled trials (RCTs) assessing the effect of infraclavicular versus supraclavicular nerve block for upper limb surgeries were included. We excluded studies reporting other nerve block approaches. The methodological quality of the included studies was evaluated by the modified Jadad scale. Standard mean difference with 95% confidence interval (CI) was used to assess continuous outcomes. This meta-analysis was conducted by the fixed-effect model or random-effect model based on the heterogeneity. Results: Eight RCTs and 725 patients were included in this meta-analysis. Compared with supraclavicular nerve block for upper limb surgeries, infraclavicular nerve block was able to significantly increase duration of motor block (SMD = 0.34; 95% CI = 0.12 to 0.56) and decrease readiness for surgery (SMD = −0.43; 95% CI = −0.77 to −0.10), but showed similar duration of sensory block (SMD = 0.17; 95% CI = −0.05 to 0.39), block performance time (SMD = −0.14; 95% CI = −0.51 to 0.22), onset of sensory blockade (SMD = −0.13; 95% CI = −0.59 to 0.33) and onset of motor blockade (SMD = −0.17; 95% CI = −0.26 to 0.12). No high heterogeneity was seen among the included studies. Conclusion: Infraclavicular nerve block may be superior to control the analgesia for upper limb surgeries than supraclavicular nerve block.