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Efficacy of axillary versus infraclavicular brachial plexus block in preventing tourniquet pain: A randomised trial.
Eur J Anaesthesiol. 2019 01; 36(1):48-54.EJ

Abstract

BACKGROUND

Axillary and infraclavicular brachial plexus blocks are commonly used for upper limb surgery. Clinicians require information on the relative benefits of each to make a rational selection for specific patients and procedures.

OBJECTIVES

The main objective of the study was to compare axillary and infraclavicular brachial plexus block in terms of the incidence and severity of tourniquet pain.

DESIGN

Single blinded, randomised trial.

SETTING

University affiliated hospital, level-1 trauma centre.

PATIENTS

Age more than 18 years, ASAI-III patients undergoing orthopaedic surgery distal to the elbow, with an anticipated tourniquet duration of more than 45 min were recruited.

INTERVENTIONS

Patients underwent either ultrasound guided axillary brachial plexus block or infraclavicular block (ICB).

MAIN OUTCOME MEASURES

Incidence of tourniquet pain (onset, severity, associated haemodynamic changes) and block characteristics (block performance/onset times, distribution, incidence of adverse events, patient satisfaction) were recorded.

RESULTS

Eighty two patients (40 in the axillary block and 42 in the ICB group) were recruited. The incidence (5/36 and 3/35; P = 0.71), onset time (73.0 ± 14.8 and 86.6 ± 5.7 min; P = 0.18) and severity (mild/moderate; 4/1 and 1/2; P = 0.51) of tourniquet pain were similar in the two groups. The incidence of paraesthesia during block performance, and block performance time were greater in the axillary block group (P = 0.0054 and 0.012, respectively). The volume of local anaesthetic administered was greater in the ICB group (P < 0.01). ICB was associated with a greater degree of sensory block in the distributions of both the axillary nerve and the medial cutaneous brachial nerve (P < 0.01). Overall patient satisfaction and incidence of inadvertent vascular puncture were similar in the two groups.

CONCLUSION

For surgical procedures which are of moderate duration, infraclavicular and axillary blocks are associated with similar incidences of tourniquet pain. Other factors appear to differentiate between these two blocks, namely block performance time, incidence of paraesthesia and dose of local anaesthetic.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT02714738.

Authors+Show Affiliations

From the Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland (DB, GI, PM, GS).No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

30461447

Citation

Brenner, David, et al. "Efficacy of Axillary Versus Infraclavicular Brachial Plexus Block in Preventing Tourniquet Pain: a Randomised Trial." European Journal of Anaesthesiology, vol. 36, no. 1, 2019, pp. 48-54.
Brenner D, Iohom G, Mahon P, et al. Efficacy of axillary versus infraclavicular brachial plexus block in preventing tourniquet pain: A randomised trial. Eur J Anaesthesiol. 2019;36(1):48-54.
Brenner, D., Iohom, G., Mahon, P., & Shorten, G. (2019). Efficacy of axillary versus infraclavicular brachial plexus block in preventing tourniquet pain: A randomised trial. European Journal of Anaesthesiology, 36(1), 48-54. https://doi.org/10.1097/EJA.0000000000000928
Brenner D, et al. Efficacy of Axillary Versus Infraclavicular Brachial Plexus Block in Preventing Tourniquet Pain: a Randomised Trial. Eur J Anaesthesiol. 2019;36(1):48-54. PubMed PMID: 30461447.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of axillary versus infraclavicular brachial plexus block in preventing tourniquet pain: A randomised trial. AU - Brenner,David, AU - Iohom,Gabriella, AU - Mahon,Padraig, AU - Shorten,George, PY - 2018/11/22/pubmed PY - 2019/5/29/medline PY - 2018/11/22/entrez SP - 48 EP - 54 JF - European journal of anaesthesiology JO - Eur J Anaesthesiol VL - 36 IS - 1 N2 - BACKGROUND: Axillary and infraclavicular brachial plexus blocks are commonly used for upper limb surgery. Clinicians require information on the relative benefits of each to make a rational selection for specific patients and procedures. OBJECTIVES: The main objective of the study was to compare axillary and infraclavicular brachial plexus block in terms of the incidence and severity of tourniquet pain. DESIGN: Single blinded, randomised trial. SETTING: University affiliated hospital, level-1 trauma centre. PATIENTS: Age more than 18 years, ASAI-III patients undergoing orthopaedic surgery distal to the elbow, with an anticipated tourniquet duration of more than 45 min were recruited. INTERVENTIONS: Patients underwent either ultrasound guided axillary brachial plexus block or infraclavicular block (ICB). MAIN OUTCOME MEASURES: Incidence of tourniquet pain (onset, severity, associated haemodynamic changes) and block characteristics (block performance/onset times, distribution, incidence of adverse events, patient satisfaction) were recorded. RESULTS: Eighty two patients (40 in the axillary block and 42 in the ICB group) were recruited. The incidence (5/36 and 3/35; P = 0.71), onset time (73.0 ± 14.8 and 86.6 ± 5.7 min; P = 0.18) and severity (mild/moderate; 4/1 and 1/2; P = 0.51) of tourniquet pain were similar in the two groups. The incidence of paraesthesia during block performance, and block performance time were greater in the axillary block group (P = 0.0054 and 0.012, respectively). The volume of local anaesthetic administered was greater in the ICB group (P < 0.01). ICB was associated with a greater degree of sensory block in the distributions of both the axillary nerve and the medial cutaneous brachial nerve (P < 0.01). Overall patient satisfaction and incidence of inadvertent vascular puncture were similar in the two groups. CONCLUSION: For surgical procedures which are of moderate duration, infraclavicular and axillary blocks are associated with similar incidences of tourniquet pain. Other factors appear to differentiate between these two blocks, namely block performance time, incidence of paraesthesia and dose of local anaesthetic. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02714738. SN - 1365-2346 UR - https://www.unboundmedicine.com/medline/citation/30461447/Efficacy_of_axillary_versus_infraclavicular_brachial_plexus_block_in_preventing_tourniquet_pain:_A_randomised_trial_ L2 - https://doi.org/10.1097/EJA.0000000000000928 DB - PRIME DP - Unbound Medicine ER -