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Comparison of ultrasound-guided supraclavicular, infraclavicular and below-C6 interscalene brachial plexus block for upper limb surgery: a randomised, observer-blinded study.
Anaesth Intensive Care. 2015 Jul; 43(4):468-72.AI

Abstract

This prospective, randomised, observer-blinded study was conducted to compare the ease of performance and surgical effectiveness of interscalene block below the C6 nerve root with supraclavicular and infraclavicular techniques of brachial plexus block for upper arm and forearm surgery. Sixty adult patients of American Society of Anesthesiologists grade 1 to 3, undergoing upper limb surgery, were randomly allocated into three groups. Group SC received supraclavicular blockade, group IC received infraclavicular blockade and Group IS received interscalene blockade. All blocks were guided by ultrasound with nerve stimulator confirmation. The anaesthetic mixture consisted of 0.5 ml/kg of equal volumes of 0.75% ropivacaine and 2% lignocaine-adrenaline. The imaging and block performance time, onset time, success rate, duration of block, and duration of postoperative analgesia were recorded by a blinded observer. The onset time was significantly longer in the interscalene group as compared with supraclavicular and infraclavicular approaches. The imaging time and block performance time were comparable between groups. No significant differences were observed between the three groups in terms of block-related pain scores, success rates, duration of block or of postoperative analgesia. Two patients in the interscalene group developed clinically detectable phrenic nerve palsy. Our findings indicate that, although interscalene block below the C6 nerve root can provide surgical anaesthesia for forearm and hand surgery, it appears to have a longer onset time than supra- and infraclavicular approaches and an unacceptable incidence of phrenic nerve palsy.

Authors+Show Affiliations

Additional Professor, Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.Professor, Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.Ex-Professor and Head, Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

26099758

Citation

Bharti, N, et al. "Comparison of Ultrasound-guided Supraclavicular, Infraclavicular and below-C6 Interscalene Brachial Plexus Block for Upper Limb Surgery: a Randomised, Observer-blinded Study." Anaesthesia and Intensive Care, vol. 43, no. 4, 2015, pp. 468-72.
Bharti N, Bhardawaj N, Wig J. Comparison of ultrasound-guided supraclavicular, infraclavicular and below-C6 interscalene brachial plexus block for upper limb surgery: a randomised, observer-blinded study. Anaesth Intensive Care. 2015;43(4):468-72.
Bharti, N., Bhardawaj, N., & Wig, J. (2015). Comparison of ultrasound-guided supraclavicular, infraclavicular and below-C6 interscalene brachial plexus block for upper limb surgery: a randomised, observer-blinded study. Anaesthesia and Intensive Care, 43(4), 468-72.
Bharti N, Bhardawaj N, Wig J. Comparison of Ultrasound-guided Supraclavicular, Infraclavicular and below-C6 Interscalene Brachial Plexus Block for Upper Limb Surgery: a Randomised, Observer-blinded Study. Anaesth Intensive Care. 2015;43(4):468-72. PubMed PMID: 26099758.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of ultrasound-guided supraclavicular, infraclavicular and below-C6 interscalene brachial plexus block for upper limb surgery: a randomised, observer-blinded study. AU - Bharti,N, AU - Bhardawaj,N, AU - Wig,J, PY - 2015/6/24/entrez PY - 2015/6/24/pubmed PY - 2015/8/14/medline KW - infraclavicular block KW - interscalene block KW - success rate KW - supraclavicular block KW - upper arm and forearm surgery SP - 468 EP - 72 JF - Anaesthesia and intensive care JO - Anaesth Intensive Care VL - 43 IS - 4 N2 - This prospective, randomised, observer-blinded study was conducted to compare the ease of performance and surgical effectiveness of interscalene block below the C6 nerve root with supraclavicular and infraclavicular techniques of brachial plexus block for upper arm and forearm surgery. Sixty adult patients of American Society of Anesthesiologists grade 1 to 3, undergoing upper limb surgery, were randomly allocated into three groups. Group SC received supraclavicular blockade, group IC received infraclavicular blockade and Group IS received interscalene blockade. All blocks were guided by ultrasound with nerve stimulator confirmation. The anaesthetic mixture consisted of 0.5 ml/kg of equal volumes of 0.75% ropivacaine and 2% lignocaine-adrenaline. The imaging and block performance time, onset time, success rate, duration of block, and duration of postoperative analgesia were recorded by a blinded observer. The onset time was significantly longer in the interscalene group as compared with supraclavicular and infraclavicular approaches. The imaging time and block performance time were comparable between groups. No significant differences were observed between the three groups in terms of block-related pain scores, success rates, duration of block or of postoperative analgesia. Two patients in the interscalene group developed clinically detectable phrenic nerve palsy. Our findings indicate that, although interscalene block below the C6 nerve root can provide surgical anaesthesia for forearm and hand surgery, it appears to have a longer onset time than supra- and infraclavicular approaches and an unacceptable incidence of phrenic nerve palsy. SN - 0310-057X UR - https://www.unboundmedicine.com/medline/citation/26099758/Comparison_of_ultrasound_guided_supraclavicular_infraclavicular_and_below_C6_interscalene_brachial_plexus_block_for_upper_limb_surgery:_a_randomised_observer_blinded_study_ L2 - https://journals.sagepub.com/doi/10.1177/0310057X1504300408?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -