The Need for Supplemental Blocks in Infraclavicular Brachial Plexus Blocks
Study Details
Study Description
Brief Summary
Theoretically all surgeries below mid-humerus can be done under infraclavicular (IC) blocks. Following the introduction of ultrasonography (USG) to the clinical anesthesia, plexus and nerve blocks under the guidance of USG have gained wide acceptance for the high rates of block success, and low risk of complications (1). In this study, we aimed to evaluate the single injection and triple injection techniques in IC blocks with USG-guided medial approach, in terms of block success and the need for supplementary blocks. Our secondary goals are to compare the complication rates, sensory block durations, and to discuss the possible reasons for the failure of the blocks.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Theoretically all surgeries below mid-humerus can be done under infraclavicular (IC) blocks. Following the introduction of ultrasonography (USG) to the clinical anesthesia, plexus and nerve blocks under the guidance of USG have gained wide acceptance for the high rates of block success, and low risk of complications. At the same time, it was also shown that USG-guided IC blocks can shorten procedural times and accelerate the onset of the blocks.
Several methods for IC blocks have been described. Based on the anatomical knowledge, we hypothesized that in medial approaches the need for supplementary blocks would be low with single injections as well as triple injections. In this study, we aimed to evaluate the single injection and triple injection techniques in IC blocks with USG-guided medial approach, in terms of block success and the need for supplementary blocks. Our secondary goals are to compare the complication rates, sensory block durations, and to discuss the possible reasons for the failure of the blocks.
Medical records of 139 patients scheduled for elective or emergent hand, wrist, forearm, elbow, and distal arm surgery were analyzed. Patients older than 14-years with ASA physical status I-III, who underwent surgery between October 2017 and March 2019 were retrospectively evaluated. Exclusion criteria included non-cooperative patients, refusal of the regional anesthesia, known neuropathy that could prevent the evaluation of the efficacy of the block, different technique used for infraclavicular brachial plexus blocks (lateral sagittal, coracoid, …etc.), and known allergy to local anesthetic drugs.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Single injection Patients who received an infraclavicular block with a single injection technique were included in Group-S. |
Procedure: Medial approach infraclavicular block with single injection
infraclavicular blocks performed with single injection
|
| Triple injection Patients who received an infraclavicular block with a triple injection technique were included in Group-T. |
Procedure: Medial approach infraclavicular block with triple injection
infraclavicular blocks performed with triple injection
|
Outcome Measures
Primary Outcome Measures
- Supplemented blocks [1 hour]
30 minutes after the block, if one or two of the median, radial, ulnar or musculocutaneous nerves were still unblocked, these nerves were located either with a peripheric nerve stimulator or an ultrasound, in the axilla or on the more distal parts of their traces on arm and forearm and then supplemented.
Secondary Outcome Measures
- Complete Failure [30 minutes]
If more than two of these nerves (median, radial, ulnar or musculocutaneous) were remained unblocked, no supplementary blocks were applied, then it was considered as having a failed block and general anesthesia was administered.
- Recovery of sensory block [24 hours]
the first time of the need for analgesics
- Discomfort during IC block [1 hour]
paresthesia during the infraclavicular block
- Inadvertent vascular puncture [1 hour]
inadvertent vascular puncture during the infraclavicular block
Eligibility Criteria
Criteria
Inclusion Criteria:
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ASA physical status I-III
-
upper extremity surgery
-
blocks were performed by the same anesthesiologist
Exclusion Criteria:
-
non-cooperative patients
-
refusal of the regional anesthesia
-
known neuropathy
-
different technique used for infraclavicular brachial plexus blocks (lateral sagittal, coracoid, …etc.)
-
known allergy to local anesthetic drugs.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Derince Training and Research Hospital | Kocaeli | Derince | Turkey | 41900 |
Sponsors and Collaborators
- Derince Training and Research Hospital
Investigators
- Study Chair: Tuncay Colak, Prof, Kocaeli University
Study Documents (Full-Text)
None provided.More Information
Publications
- Abrahams MS, Aziz MF, Fu RF, Horn JL. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2009 Mar;102(3):408-17. doi: 10.1093/bja/aen384. Epub 2009 Jan 26. Review.
- Kilka HG, Geiger P, Mehrkens HH. [Infraclavicular vertical brachial plexus blockade. A new method for anesthesia of the upper extremity. An anatomical and clinical study]. Anaesthesist. 1995 May;44(5):339-44. German.
- Li JW, Songthamwat B, Samy W, Sala-Blanch X, Karmakar MK. Ultrasound-Guided Costoclavicular Brachial Plexus Block: Sonoanatomy, Technique, and Block Dynamics. Reg Anesth Pain Med. 2017 Mar/Apr;42(2):233-240. doi: 10.1097/AAP.0000000000000566.
- U1111-1240-8832