A Comparison between Retro-Clavicular and Proximal Infraclavicular Approaches for Brachial Plexus Block for Anesthesia of the Upper Limb

Abstract

Background: This comparative study hypothesize there are differences betweenultrasound guided retroclavicularand proximal infraclavicular approaches for brachial plexus block for surgeriesinvolving lowerpart of arm, elbow, forearm and hand with the use of tourniquet.Method: About 36 patients randomly allocated into 2 groups, first group block done through retro-clavicularapproach (RCB) and the other group done by using proximalinfraclavicular block (PIB).In RCB groupneedle inserted posterior to the clavicle and directed posterior to the first part of axillary artery. In PIBneedle inserted from lateral to medial after abduction of the arm more than 90° where the cords are clusteredtogether.Results: Block performance time was (6.11±2.58) and (6.05±2.61) for RCB and PIB, respectively withoutsignificant difference (p= 0.94). The onset of sensory was (12.8±1.4) and (11±2.3) for RCB and PIB,respectively. For motor onset (17.4 ±2.3) and (15.3±3.3) and there is significant difference between bothgroups (p=0.009 and 0.04), respectively. There was no significant difference in block-related pain betweenthe two groups (p=0.809) VRS for RCB was (1.41±0.712) and for PIB was (1.32±0.67). Tourniquetpainreported by the patientfor RCB was 1.24±0.56 and for PIB was 1.11±0.315, there is no significant differencebetween both groups (p=0.392)Conclusion: Ultrasound guided BPB by retro-clavicular and proximal approaches are with a comparablequality of surgical anesthesia for operations of the lower arm, elbow, forearm and hand with the use oftourniquet, the onset of surgical anesthesia is earlier for PIB, the RCB is preferred for patients who cannotabduct the arm.