Use of a curved needle to facilitate lateral sagittal infraclavicular block performance: a randomized clinical trial

Abstract

Failed needle-tip positioning in an ultrasound-guided infraclavicular block can be due to improper needle insertion point and steep needle insertion angle. Needle pre-curving enables the user to pass the needle with different curved trajectories on approaching the brachial plexus. Aim of the study was to compare curved and non-curved needles as regards the time needed to perform the lateral sagittal infra-clavicular block. Sixty-nine patients undergoing surgery distal to the elbow were randomly allocated to two groups: group A (n = 35), which received ultrasound-guided infraclavicular block using the curved needle; and group B (n = 34), which received the infraclavicular block using the non-curved needle. The primary outcome measure was the time needed to perform the infraclavicular block. Anesthetist's experience with the curved vs. non-curved needle was noted. Mean (SD) recognition time (120 ± 48 vs. 179 ± 72s, P = 0.0002) and injection time (54 ± 23 vs. 88 ± 36s, P = 0.0001) were shorter in group A compared to group B. Median (IQR) procedure pain score was less in group A 2 (1-2) than in group B 2 (2-3); P = 0.001. Median (IQR) satisfaction score was higher with regards to the curved needle 4 (4-5) than non-curved needle 3 (3-4) in performing infraclavicular blockade; P = 0.001. The use of a curved needle reduces the time required to perform the lateral sagittal infraclavicular block. The curved needle provides less procedure pain and higher satisfaction levels among anesthetists than the non-curved needle. The trial was registered (04/26/2016) with the ClinicalTrials.gov ID: NCT02799576. Approval Number: #2543. Board Name: Research Ethics Committee. Board Affiliation: Suez Canal University, Faculty of Medicine, Suez Canal University hospital, Ismailia, Egypt, 41522.