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Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach: A Randomized Observer Blind Trial.
Biomed Res Int. 2016; 2016:7094121.BR

Abstract

Background.

Distal arm surgery is widely performed under regional anesthesia with brachial plexus block. The preponderance of evidence for the efficacy relies upon injection of local anesthetic in excess of 30 mL. We aimed to compare three different ultrasound-guided brachial plexus block techniques restricting the total volume to 20 mL. Methods. 120 patients were prospectively randomized to ultrasound-guided brachial plexus block with 20 mL ropivacaine 0.75% at either the supraclavicular, infraclavicular, or axillary level. Multiinjection technique was performed with all three approaches. Primary outcome measure was performance time.

Results.

Performance time and procedural pain were similar between groups. Needle passes and injection numbers were significantly reduced in the infraclavicular group (P < 0.01). Nerve visibility was significantly reduced in the axillary group (P = 0.01). Success-rate was significantly increased in the supraclavicular versus the axillary group (P < 0.025). Total anesthesia-related time was significantly reduced in the supraclavicular compared to the infraclavicular group (P < 0.01). Block duration was significantly increased in the infraclavicular group (P < 0.05). No early adverse effects occurred.

Conclusion.

Supraclavicular and infraclavicular blocks exhibited favorable characteristics compared to the axillary block. Supraclavicular brachial plexus block with the multiinjection intracluster technique exhibited significantly reduced total anesthesia-related time and higher success rate without any early adverse events.

Authors+Show Affiliations

Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.Department of Anesthesia and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Sygehusvej 10, 4000 Roskilde, Denmark.Department of Anesthesia & Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.Department of Anesthesia and Intensive Care Medicine, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark.Department of Anesthesia and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Sygehusvej 10, 4000 Roskilde, Denmark.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27990435

Citation

Vazin, Mojgan, et al. "Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach: a Randomized Observer Blind Trial." BioMed Research International, vol. 2016, 2016, p. 7094121.
Vazin M, Jensen K, Kristensen DL, et al. Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach: A Randomized Observer Blind Trial. Biomed Res Int. 2016;2016:7094121.
Vazin, M., Jensen, K., Kristensen, D. L., Hjort, M., Tanggaard, K., Karmakar, M. K., Bendtsen, T. F., & Børglum, J. (2016). Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach: A Randomized Observer Blind Trial. BioMed Research International, 2016, 7094121.
Vazin M, et al. Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach: a Randomized Observer Blind Trial. Biomed Res Int. 2016;2016:7094121. PubMed PMID: 27990435.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach: A Randomized Observer Blind Trial. AU - Vazin,Mojgan, AU - Jensen,Kenneth, AU - Kristensen,Danja L, AU - Hjort,Mathias, AU - Tanggaard,Katrine, AU - Karmakar,Manoj K, AU - Bendtsen,Thomas F, AU - Børglum,Jens, Y1 - 2016/11/21/ PY - 2016/08/05/received PY - 2016/10/31/accepted PY - 2016/12/20/entrez PY - 2016/12/19/pubmed PY - 2017/2/14/medline SP - 7094121 EP - 7094121 JF - BioMed research international JO - Biomed Res Int VL - 2016 N2 - Background. Distal arm surgery is widely performed under regional anesthesia with brachial plexus block. The preponderance of evidence for the efficacy relies upon injection of local anesthetic in excess of 30 mL. We aimed to compare three different ultrasound-guided brachial plexus block techniques restricting the total volume to 20 mL. Methods. 120 patients were prospectively randomized to ultrasound-guided brachial plexus block with 20 mL ropivacaine 0.75% at either the supraclavicular, infraclavicular, or axillary level. Multiinjection technique was performed with all three approaches. Primary outcome measure was performance time. Results. Performance time and procedural pain were similar between groups. Needle passes and injection numbers were significantly reduced in the infraclavicular group (P < 0.01). Nerve visibility was significantly reduced in the axillary group (P = 0.01). Success-rate was significantly increased in the supraclavicular versus the axillary group (P < 0.025). Total anesthesia-related time was significantly reduced in the supraclavicular compared to the infraclavicular group (P < 0.01). Block duration was significantly increased in the infraclavicular group (P < 0.05). No early adverse effects occurred. Conclusion. Supraclavicular and infraclavicular blocks exhibited favorable characteristics compared to the axillary block. Supraclavicular brachial plexus block with the multiinjection intracluster technique exhibited significantly reduced total anesthesia-related time and higher success rate without any early adverse events. SN - 2314-6141 UR - https://www.unboundmedicine.com/medline/citation/27990435/Low_Volume_Brachial_Plexus_Block_Providing_Surgical_Anesthesia_for_Distal_Arm_Surgery_Comparing_Supraclavicular_Infraclavicular_and_Axillary_Approach:_A_Randomized_Observer_Blind_Trial_ L2 - https://doi.org/10.1155/2016/7094121 DB - PRIME DP - Unbound Medicine ER -