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Infraclavicular brachial plexus block for regional anaesthesia of the lower arm.
Anesth Analg. 2010 Oct; 111(4):1072.A&A

Abstract

BACKGROUND

Several approaches exist to produce local anaesthetic blockade of the brachial plexus. It is not clear which is the technique of choice for providing surgical anaesthesia of the lower arm although infraclavicular blockade (ICB) has several purported advantages. We therefore performed a systematic review of ICB compared to the other brachial plexus blocks (BPBs).

OBJECTIVES

To evaluate the efficacy and safety of ICB compared to other BPBs in providing regional anaesthesia of the lower arm.

SEARCH STRATEGY

We searched CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE (1950 to September 22nd 2008) and EMBASE (1980 to September 22nd 2008). We also searched conference proceedings (from 2004 to 2008) and the www.clinicaltrials.gov registry. No language restriction was applied.

SELECTION CRITERIA

We included any randomized controlled trials (RCTs) that compared ICB with other BPBs as the sole anaesthetic techniques for surgery on the lower arm.

DATA COLLECTION AND ANALYSIS

The primary outcome was adequate surgical anaesthesia within 30 minutes of block completion. Secondary outcomes included sensory block of individual nerves, tourniquet pain, onset time of sensory blockade, block performance time, block-associated pain and complications related to the block.

MAIN RESULTS

We identified 15 studies with 1020 participants, of whom 510 received ICB and 510 received other BPBs. The control group intervention was the axillary block in 10 studies, mid-humeral block in two studies, supraclavicular block in two studies and parascalene block in one study. Three studies employed ultrasound-guided ICB. The risk of failed surgical anaesthesia and of complications were low and similar for ICB and all other BPBs. Tourniquet pain was less likely with ICB (risk ratio (RR) 0.47, 95% CI 0.24 to 0.92, P = 0.03). When compared to a single-injection axillary block, ICB was better at providing complete sensory block of the musculocutaneous nerve (RR for failure 0.46, 95% CI 0.27 to 0.60, P < 0.0001) and the axillary nerve (RR of failure 0.37, 95% CI 0.24 to 0.58, P < 0.0001). ICB was faster to perform than multiple-injection axillary (mean difference (MD) -2.7 min, 95% CI -4.2 to -1.1, P = 0.0006) or midhumeral blocks (MD -4.8 min, 95% CI -6.0 to -3.6, P < 0.00001) but this was offset by a longer sensory block onset time (MD 3.9 min, 95% CI 3.2 to 4.5, P < 0.00001).

AUTHORS' CONCLUSIONS

ICB is a safe and simple technique for providing surgical anaesthesia of the lower arm, with an efficacy comparable to other BPBs. The advantages of ICB include a lower likelihood of tourniquet pain during surgery, and more reliable blockade of the musculocutaneous and axillary nerves when compared to a single-injection axillary block. The efficacy of ICB is likely to be improved if adequate time is allowed for block onset (at least 30 minutes) and if a volume of at least 40 ml is injected. Since publication of many of the trials included in this review, it has become clear that a distal posterior cord motor response is the appropriate endpoint for electrostimulation-guided ICB; we recommend it be used in all future comparative studies. There is also a need for additional RCTs comparing ultrasound-guided ICB with other BPBs.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Review
Systematic Review

Language

eng

PubMed ID

20870985

Citation

Chin, Ki Jinn, et al. "Infraclavicular Brachial Plexus Block for Regional Anaesthesia of the Lower Arm." Anesthesia and Analgesia, vol. 111, no. 4, 2010, p. 1072.
Chin KJ, Singh M, Velayutham V, et al. Infraclavicular brachial plexus block for regional anaesthesia of the lower arm. Anesth Analg. 2010;111(4):1072.
Chin, K. J., Singh, M., Velayutham, V., & Chee, V. (2010). Infraclavicular brachial plexus block for regional anaesthesia of the lower arm. Anesthesia and Analgesia, 111(4), 1072. https://doi.org/10.1213/ANE.0b013e3181dbac5d
Chin KJ, et al. Infraclavicular Brachial Plexus Block for Regional Anaesthesia of the Lower Arm. Anesth Analg. 2010;111(4):1072. PubMed PMID: 20870985.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Infraclavicular brachial plexus block for regional anaesthesia of the lower arm. AU - Chin,Ki Jinn, AU - Singh,Mandeep, AU - Velayutham,Veerabadran, AU - Chee,Victor, PY - 2010/9/28/entrez PY - 2010/9/28/pubmed PY - 2010/10/12/medline SP - 1072 EP - 1072 JF - Anesthesia and analgesia JO - Anesth Analg VL - 111 IS - 4 N2 - BACKGROUND: Several approaches exist to produce local anaesthetic blockade of the brachial plexus. It is not clear which is the technique of choice for providing surgical anaesthesia of the lower arm although infraclavicular blockade (ICB) has several purported advantages. We therefore performed a systematic review of ICB compared to the other brachial plexus blocks (BPBs). OBJECTIVES: To evaluate the efficacy and safety of ICB compared to other BPBs in providing regional anaesthesia of the lower arm. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE (1950 to September 22nd 2008) and EMBASE (1980 to September 22nd 2008). We also searched conference proceedings (from 2004 to 2008) and the www.clinicaltrials.gov registry. No language restriction was applied. SELECTION CRITERIA: We included any randomized controlled trials (RCTs) that compared ICB with other BPBs as the sole anaesthetic techniques for surgery on the lower arm. DATA COLLECTION AND ANALYSIS: The primary outcome was adequate surgical anaesthesia within 30 minutes of block completion. Secondary outcomes included sensory block of individual nerves, tourniquet pain, onset time of sensory blockade, block performance time, block-associated pain and complications related to the block. MAIN RESULTS: We identified 15 studies with 1020 participants, of whom 510 received ICB and 510 received other BPBs. The control group intervention was the axillary block in 10 studies, mid-humeral block in two studies, supraclavicular block in two studies and parascalene block in one study. Three studies employed ultrasound-guided ICB. The risk of failed surgical anaesthesia and of complications were low and similar for ICB and all other BPBs. Tourniquet pain was less likely with ICB (risk ratio (RR) 0.47, 95% CI 0.24 to 0.92, P = 0.03). When compared to a single-injection axillary block, ICB was better at providing complete sensory block of the musculocutaneous nerve (RR for failure 0.46, 95% CI 0.27 to 0.60, P < 0.0001) and the axillary nerve (RR of failure 0.37, 95% CI 0.24 to 0.58, P < 0.0001). ICB was faster to perform than multiple-injection axillary (mean difference (MD) -2.7 min, 95% CI -4.2 to -1.1, P = 0.0006) or midhumeral blocks (MD -4.8 min, 95% CI -6.0 to -3.6, P < 0.00001) but this was offset by a longer sensory block onset time (MD 3.9 min, 95% CI 3.2 to 4.5, P < 0.00001). AUTHORS' CONCLUSIONS: ICB is a safe and simple technique for providing surgical anaesthesia of the lower arm, with an efficacy comparable to other BPBs. The advantages of ICB include a lower likelihood of tourniquet pain during surgery, and more reliable blockade of the musculocutaneous and axillary nerves when compared to a single-injection axillary block. The efficacy of ICB is likely to be improved if adequate time is allowed for block onset (at least 30 minutes) and if a volume of at least 40 ml is injected. Since publication of many of the trials included in this review, it has become clear that a distal posterior cord motor response is the appropriate endpoint for electrostimulation-guided ICB; we recommend it be used in all future comparative studies. There is also a need for additional RCTs comparing ultrasound-guided ICB with other BPBs. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/20870985/Infraclavicular_brachial_plexus_block_for_regional_anaesthesia_of_the_lower_arm_ L2 - https://doi.org/10.1213/ANE.0b013e3181dbac5d DB - PRIME DP - Unbound Medicine ER -