Comparison of Ultrasound guided supraclavicular and infraclavicular approaches for brachial plexus blockade.

Abstract

OBJECTIVES Ultrasound-guided supraclavicular and infraclavicular blocks are commonly used for upper extremity surgery. The primary aims of our study were to compare block success, block onset times and performance times; secondary aims were to compare the number of needle advancements, and incidence of adverse events of ultrasound-guided supraclavicular or infraclavicular blocks. METHODS 110 patients were randomized into two groups: supraclavicular (Group S) and infraclavicular (Group I). All the patients were given a mixture of 20 ml 0.5% levobupivacaine and 10 ml 2% lidocaine as local anesthetics. The sensory score of the seven terminal nerves was assessed every 10 min for 30 min. RESULTS Block success (Group I: 92.7%; Group S: 83.6%) and block onset time (Group I: 12.5 ± 4.8; Group S: 11.6 ± 3.9 min) were similar between the groups. Block performance time was shorter in Group I, than Group S (194.4 ± 65; 226.3 ± 59 sec, P<0.05). The number of needle advancements were lower in Group I than Group S (p<0.05). The Group I patients had a significantly improved block of the median and ulnar nerves than Group S, and Group S patients had a better block of the medial cutaneous nerve, than Group I (p<0.05). Horner syndrome was observed in 9 patients (16.3%) and paresthesia in one patient (1.8%) in Group S. CONCLUSION Similar block features were observed with infraclavicular and supraclavicular approaches, but infraclavicular block may be preferable to supraclavicular block due to the lower incidence of transient adverse events.