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

Abstract

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. 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. 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. 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.