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A prospective, randomized comparison between ultrasound-guided supraclavicular, infraclavicular, and axillary brachial plexus blocks.
Reg Anesth Pain Med. 2009 Jul-Aug; 34(4):366-71.RA

Abstract

BACKGROUND

This prospective, randomized, observer-blinded study compared ultrasound-guided supraclavicular (SCB), infraclavicular (ICB), and axillary (AXB) brachial plexus blocks for upper extremity surgery of the elbow, forearm, wrist, and hand.

METHODS

One hundred twenty patients were randomly allocated to receive an ultrasound-guided SCB (n = 40), ICB (n = 40), or AXB (n = 40). Performance time (defined as the sum of imaging and needling times) and the number of needle passes were recorded during the performance of the block. Subsequently, a blinded observer recorded the onset time, block-related pain scores, success rate (surgical anesthesia), and the incidence of complications. The main outcome variable was the total anesthesia-related time, defined as the sum of performance and onset times.

RESULTS

No differences were observed between the 3 groups in terms of total anesthesia-related time (23.1-25.5 mins), success rate (95%-97.5%), block-related pain scores, vascular puncture, and paresthesia. Compared with the supraclavicular and infraclavicular approaches, ultrasound-guided AXBs required a higher number of needle passes (6.1 [SD, 2.0] vs 2.0-2.6 [SD, 1.1-1.8]; both P < or = 0.001), a longer needling time (7.4 mins [SD, 2.2 mins] vs 4.9-5.5 mins [SD, 1.9-4.2 mins]; both P < or = 0.016), and a longer performance time (8.5 mins [SD, 2.3 mins] vs 6.0-6.2 mins [SD, 2.1-4.5 mins]; both P < or = 0.008). Supraclavicular blocks resulted in a higher rate of Horner syndrome (37.5% vs 0%-5%; both P < 0.001).

CONCLUSION

Adjunctive ultrasonography results in similar success rates, total anesthesia-related times, and block-related pain scores for the SCB, ICB, and AXB.

Authors+Show Affiliations

Department of Anesthesia, Montreal General Hospital, 1650 Ave Cedar, D10-144 Montreal, Quebec H3G-1A4, Canada. de_tran@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19574871

Citation

Tran, De Quang Hieu, et al. "A Prospective, Randomized Comparison Between Ultrasound-guided Supraclavicular, Infraclavicular, and Axillary Brachial Plexus Blocks." Regional Anesthesia and Pain Medicine, vol. 34, no. 4, 2009, pp. 366-71.
Tran DQ, Russo G, Muñoz L, et al. A prospective, randomized comparison between ultrasound-guided supraclavicular, infraclavicular, and axillary brachial plexus blocks. Reg Anesth Pain Med. 2009;34(4):366-71.
Tran, D. Q., Russo, G., Muñoz, L., Zaouter, C., & Finlayson, R. J. (2009). A prospective, randomized comparison between ultrasound-guided supraclavicular, infraclavicular, and axillary brachial plexus blocks. Regional Anesthesia and Pain Medicine, 34(4), 366-71. https://doi.org/10.1097/AAP.0b013e3181ac7d18
Tran DQ, et al. A Prospective, Randomized Comparison Between Ultrasound-guided Supraclavicular, Infraclavicular, and Axillary Brachial Plexus Blocks. Reg Anesth Pain Med. 2009 Jul-Aug;34(4):366-71. PubMed PMID: 19574871.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A prospective, randomized comparison between ultrasound-guided supraclavicular, infraclavicular, and axillary brachial plexus blocks. AU - Tran,De Quang Hieu, AU - Russo,Gianluca, AU - Muñoz,Loreto, AU - Zaouter,Cedrick, AU - Finlayson,Roderick J, PY - 2009/7/4/entrez PY - 2009/7/4/pubmed PY - 2009/10/29/medline SP - 366 EP - 71 JF - Regional anesthesia and pain medicine JO - Reg Anesth Pain Med VL - 34 IS - 4 N2 - BACKGROUND: This prospective, randomized, observer-blinded study compared ultrasound-guided supraclavicular (SCB), infraclavicular (ICB), and axillary (AXB) brachial plexus blocks for upper extremity surgery of the elbow, forearm, wrist, and hand. METHODS: One hundred twenty patients were randomly allocated to receive an ultrasound-guided SCB (n = 40), ICB (n = 40), or AXB (n = 40). Performance time (defined as the sum of imaging and needling times) and the number of needle passes were recorded during the performance of the block. Subsequently, a blinded observer recorded the onset time, block-related pain scores, success rate (surgical anesthesia), and the incidence of complications. The main outcome variable was the total anesthesia-related time, defined as the sum of performance and onset times. RESULTS: No differences were observed between the 3 groups in terms of total anesthesia-related time (23.1-25.5 mins), success rate (95%-97.5%), block-related pain scores, vascular puncture, and paresthesia. Compared with the supraclavicular and infraclavicular approaches, ultrasound-guided AXBs required a higher number of needle passes (6.1 [SD, 2.0] vs 2.0-2.6 [SD, 1.1-1.8]; both P < or = 0.001), a longer needling time (7.4 mins [SD, 2.2 mins] vs 4.9-5.5 mins [SD, 1.9-4.2 mins]; both P < or = 0.016), and a longer performance time (8.5 mins [SD, 2.3 mins] vs 6.0-6.2 mins [SD, 2.1-4.5 mins]; both P < or = 0.008). Supraclavicular blocks resulted in a higher rate of Horner syndrome (37.5% vs 0%-5%; both P < 0.001). CONCLUSION: Adjunctive ultrasonography results in similar success rates, total anesthesia-related times, and block-related pain scores for the SCB, ICB, and AXB. SN - 1532-8651 UR - https://www.unboundmedicine.com/medline/citation/19574871/A_prospective_randomized_comparison_between_ultrasound_guided_supraclavicular_infraclavicular_and_axillary_brachial_plexus_blocks_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=19574871.ui DB - PRIME DP - Unbound Medicine ER -