Infraclavicular Brachial Plexus Block Research Articles

0.25% bupivacaine–1% lidocaine vs 0.5% bupivacaine for ultrasound-guided infraclavicular brachial plexus block: a randomized controlled trial

IntroductionIn an effort to shorten onset time, a common practice is to add lidocaine to bupivacaine. In the setting of infraclavicular block, it is unclear what the block characteristics of...

Ultrasound guided costoclavicular block in pediatric population: A prospective observational study.

The costoclavicular space serves as an alternative approach to the infraclavicular brachial plexus block, and numerous studies in adults have demonstrated promising outcomes for distal upper limb surgery. Blocking the brachial plexus at this level is potentially advantageous because the cords are relatively superficial, located in close proximity to each other and easily identified using ultrasound. This study aimed to assess the success rate and feasibility of costoclavicular block in children undergoing unilateral below elbow upper limb surgery. Thirty children aged 2-12 years scheduled for unilateral below elbow surgery under general anesthesia were included. Costoclavicular block was performed under ultrasound and nerve stimulator guidance with 0.5% ropivacaine, 0.5 mL/kg. Success was evaluated based on the absence of significant hemodynamic response to skin incision made 20 min after the block. The sono-anatomy of costoclavicular space, ease of needling, complications, and the post-operative pain scores were assessed. The mean age and weight of the children were 6.5 ± 3.8 years and 19.7 ± 9.1 kg, respectively. The success rate of costoclavicular block in our cohort is 100%. Sonographic visualization was graded as excellent (Likert Scale 2) in 90% of cases. The plexus was located at a depth of 1.4 ± 0.3 cm from the skin, the lateral extent of cords from the artery was 0.8 ± 0.4 cm and they were observed inferior and lateral to the artery. The mean needling time was 3.6 ± 1.1 min. None of the children experienced complications such as vascular or pleural puncture, hematoma, Horner's syndrome or diaphragmatic palsy. Postoperative pain scores were low, and no rescue analgesia was required. In conclusion, the costoclavicular block exhibited a notably high success rate in pediatric population. This study substantiates that the three cords of the brachial plexus are consistently visible and superficial during ultrasound examination using this approach, confirming their separation from vascular structures and the reliable achievement of blockade without observed complications.

Efficacy of Infraclavicular Brachial Plexus Block Alone Versus Combination With Suprascapular Nerve Block in Patients Undergoing Shoulder Surgeries: A Single-Blind, Randomized Trial.

Background and aim The regional anesthesia technique is commonly used for upper extremity surgery as an alternative to general anesthesia. The study aimed to compare the efficacy of infraclavicular brachial plexus block (BPB) and a combination of infraclavicular brachial plexus block with suprascapular nerve block for postoperative analgesia in patients undergoing shoulder surgeries. Method A total of 62 patients of both sexes with the American Society of Anaesthesiologists (ASA) physical status I/II/III, aged between 18 and 65 years, and undergoing shoulder surgery, were included in this prospective, single-blinded, randomized controlled trial. Patients were equally allocated into two groups: 31 in group A and 31 in group B.After pre-anesthetic evaluation, the purpose and protocol of the study were explained to patients, and informed consent was obtained. Thirty-one patients in group A were given infraclavicular brachial plexus block using 30 ml 0.375% bupivacainewhile 31 patients in group B were given a combination of infraclavicular brachial plexus block using 30 ml 0.375% bupivacaine and suprascapular nerve block using 5 ml 0.375% bupivacaine.Blocks were given using ultrasound guidance and a peripheral nerve stimulator; the suprascapular block was given in the sitting positionwhile the infraclavicular block was provided in the supine position. General anesthesia was administered in the operation theatre in the supine position after the administration of blocks. The pain was assessed using the visual analog scale (VAS) and the satisfaction score was assessed by the numeric rating scale (NRS). The Mann-Whitney U test was applied for comparison of pain between the two groups. The chi-square test was utilized for comparing the categorical variables. Result The postoperative pain was significantly lower (p<0.001) in group B as compared to group A at all the periods of observation, i.e., 0h (2.77±0.72 vs. 5.42±0.77), 6h (3.89±0.70 vs. 5.94±0.73), 12h (5.66±0.93 vs. 6.58±0.88), and 24h (6.16±0.80 vs. 6.74±0.90). These findings illustrate that group B patients who received a combination of infraclavicular brachial plexus block and suprascapular nerve block for shoulder surgeries had better pain relief than group A patients who received only the infraclavicular approach. The mean NRS score of patient satisfaction in group B (7.26±0.58) was significantly higher (p<0.001) in comparison to group A (6.16±0.64). Diaphragmatic palsy was observed in only one case in group A and none in group B. No other complication was observed in any of the patients during the study period. Conclusion The combination of infraclavicular brachial plexus block and suprascapular nerve blockdisplays a positive postoperative analgesic profile with less usage of rescue analgesic doses and better patient satisfaction after shoulder surgery.

Puncture site bleeding complications of peripheral nerve block in patients taking antithrombotic and anticoagulant drugs: An umbrella review

background: While there are multiple guidelines for the management of bleeding complications and hematoma if being treated with antithrombotic and anticoagulant drugs, these risks are not yet stratified for procedures with regional anesthesia. Materials and Methods: This study was an umbrella review of systematic studies and meta-analysis based on PRISMA guidelines in databases of Scopus, PubMed, Medline, Cochrane Library, and Web of Science databases. Due to heterogeneity in evaluated outcomes and methods of studies, only the qualitative evidence synthesis was performed. AMSTAR checklist was used to assess the risk of bias in included systematic reviews. Results: After an extensive search of relevant studies, 971 primary cases were identified. Following a thorough screening process, 5 systematic reviews were selected. The evidence suggests that head and neck punctures generally do not result in bleeding complications, except for rare cases of hematoma associated with Infraclavicular brachial plexus block. A deep cervical plexus block is not recommended. Interscalene blocks have varying findings, with some studies reporting hematoma incidence and spinal injury, while others consider them low risk. Supraclavicular brachial plexus block might be associated with hemothorax and infraclavicular blocks are not favored by reviews. Axillary brachial plexus blocks have a minor incidence of hematoma. Abdomen blocks, TAP blocks, ilioinguinal blocks, and rectus sheath blocks carry a higher risk of hematoma. Pectoral nerve (PECS) blocks have a relatively high risk, while paravertebral and intercostal blocks are considered high risk, but further research is needed regarding paravertebral blocks. Conclusion: The available evidence from systematic reviews and studies suggests varying levels of risk for different blocks and procedures that should be considered before decision-making.

The effect of oral dexamethasone on duration of analgesia after upper limb surgery under infraclavicular brachial plexus block: a randomised controlled trial.

The effects of oral dexamethasone on peripheral nerve blocks have not been investigated. We randomly allocated adults scheduled for forearm or hand surgery to oral placebo (n = 61), dexamethasone 12 mg (n = 61) or dexamethasone 24 mg (n = 57) about 45 min before lateral infraclavicular block. Mean (SD) time until first pain after block were: 841 (327) min; 1171 (318) min; and 1256 (395) min, respectively. Mean (98.3%CI) differences in time until first postoperative pain for dexamethasone 24 mg vs. placebo and vs. dexamethasone 12 mg were: 412 (248-577) min, p < 0.001; and 85 (-78 to 249) min, p = 0.21, respectively. Mean (98.3%CI) difference in time until first postoperative pain for dexamethasone 12 mg vs. placebo was 330 (186-474) min, p < 0.001. Both 24 mg and 12 mg of oral dexamethasone increased the time until first postoperative pain compared with placebo in patients having upper limb surgery under infraclavicular brachial plexus block.

A Randomized Controlled Trial Comparing the Analgesic Efficacy of Programmed Intermittent Bolus vs. Continuous Infusion of Ropivacaine and Fentanyl in Ultrasound-Guided Infraclavicular Brachial Plexus Block for Upper Limb Surgery.

Programmed intermittent bolus (PIB) is a novel method of intermittent drug delivery commonly employed in labor epidural analgesia. This study aimed to evaluate the potential benefits of PIB over continuous infusion (CI) for postoperative analgesia following upper limb surgeries distal to the mid-humerus level using ultrasound-guided infraclavicular brachial plexus block (USG-IBPB). The USG-IBPB was performed on a total of 30 patients scheduled for upper limb surgery distal to the mid-humerus level. The patient-controlled regional analgesia pump delivered a combination of 6 mL of 0.2% ropivacaine and 2 μg/mL fentanyl via a perineural catheter as PIB in group I and as a CI in group II. The primary outcome measure was overall drug consumption, and secondary outcomes included pain scores, patient satisfaction, sensory and motor blockade, and adverse effects. The PIB group exhibited significantly lower overall drug consumption (306.20 ± 13.07 mL vs. 323.73 ± 11.79 mL; P = 0.001), a reduced need for patient-controlled analgesia boluses (3.87 ± 2.67 vs. 7.13 ± 2.36; P = 0.001), and higher patient satisfaction (91.93 ± 10.09 vs. 78.67 ± 17.57; P = 0.017) compared to the CI group. Pain scores at rest were significantly lower at the 24-hour mark (P = 0.007), and on movement, lower scores were observed after 1, 24, and 36 hours (P = 0.031, P = 0.031, and P = 0.011, respectively). Sensory block, motor block, and adverse effects were similar between the two groups. PIB demonstrated superior efficacy in postoperative analgesia compared to the CI technique for upper limb surgeries distal to the mid-humerus level. Therefore, PIB may be considered an effective alternative to CI for optimal postoperative pain management.

Impact of Peripheral Nerve Block Technique on Incidence of Phrenic Nerve Palsy in Shoulder Surgery.

Peripheral nerve blocks are an increasingly common method of providing postoperative analgesia for shoulder surgeries. However, the standard technique, the interscalene block (ISB), inevitably causes hemidiaphragmatic paresis (HDP), secondary to phrenic nerve palsy. This can cause morbidity in patients with preexisting respiratory compromise, prompting investigation into alternative "phrenic-sparing" nerve blocks. The aim of this review was to give an overview of these blocks and critically evaluate the current literature to determine if any are suitable replacements for ISB. The incidence of HDP and analgesic efficacy were considered. We queried four electronic databases and one register. Twenty-eight original articles were selected for review. The use of ultrasound guidance, lower volumes of local anaesthetic (LA), and injection 4 mm outside the brachial plexus fascia reduced HDP incidence for the ISB; however, no single modification did so sufficiently. While the anterior suprascapular nerve block (SSNB) showed comparable analgesic effects to the ISB, HDP prevalence was also high. The posterior SSNB produced consistently low HDP incidences but also inferior analgesia to ISB, except when combined with an infraclavicular brachial plexus block. The superior trunk block (STB) provided equivalent analgesia to the ISB while reducing HDP incidence, but not significantly. Lower LA volumes consistently led to lower HDP incidence across all blocks, likely due to a reduced ability to spread to the phrenic nerve. Further investigation into the minimum effective volumes of the extrafascial ISB, anterior SSNB, STB, and combined posterior SSNB with infraclavicular block is warranted to determine if any of these blocks can successfully balance HDP prevention with analgesic efficacy.

Blockade of intercostobrachial nerve by an erector spinae plane block at T2 level: a case report

BackgroundThe intercostobrachial nerve blockade is required, in addition to brachial plexus block, to anesthetize the entire upper arm. No studies have described the use of erector spinae plane (ESP) block for an intercostobrachial nerve block.Case presentationA 72-year-old man was scheduled to undergo left brachial vein transposition-arteriovenous fistula creation for hemodialysis access. An ultrasound-guided infraclavicular brachial plexus block was performed using a mixture of 0.5% levobupivacaine (12.5 ml) and 2% lidocaine (12.5 ml). An ESP block was implemented using 10 ml of the same local anesthetic at the T2 level. A pinprick test showed that the entire upper arm and lateral aspect of the left upper chest wall were anesthetized 20 min after the blocks. Surgery was successfully performed without the need for general anesthesia.ConclusionsIn the present case, an ESP block performed at the T2 level provided sensory loss of the area innervated by the intercostobrachial nerve.

The Comparison of Dexmedetomidine to Dexamethasone as Adjuvants to Bupivacaine in Ultrasound-Guided Infraclavicular Brachial Plexus Block in Upper Limb Surgeries.

Background The clinical utility of adjuvants with local anesthesia produces an excellent nerve block with prolonged duration and faster onset.Brachial plexus block is widely used nowadays in patientsundergoing upper limb surgery There are several approaches to achieve brachial plexus block such as interscalene, supraclavicular, infraclavicular, and axillary. The objective of this study is to compare the effectiveness of dexamethasone to dexmedetomidine as adjuvants to bupivacaine in patients undergoing ultrasound-guided infraclavicular brachial plexus (USG-ICBP) block. Methods A randomized, prospective, double-blind study was undertaken on the patients posted for upper limb surgeries under ultrasound-guided infraclavicular brachial plexus block. Sixtypatients with the American Society of Anesthesiologists (ASA) classes I and II were randomly allocated into two groups. Group A received 25 mL of 0.5% bupivacaine and 1.5 mL (6 mg) of dexamethasone, and group B received 25 mL of 0.5% bupivacaine and 0.75 mL (75 mcg) of dexmedetomidine along with 0.75 mL of 0.9% normal saline (NS). Student's t test or Mann-Whitney test and chi-square test were used for statistical analysis. Results The onset of sensory block was significantly faster in the patients in group B as compared to the patients in group A. In terms of the duration of the block, sensory and motor blocks were maintained for a significantly longer duration in the group A patients as compared to those in group B. Moreover, the duration of postoperative analgesia was significantly longer-lasting in the group A patients. In terms of adverse effects, procedure-related complications such as the failure of the block and inadequate block were comparable across the groups. However, drug-related adverse effects were significantly more common in group B. Conclusion As compared to 75 mcg of dexmedetomidine, the addition of 6 mg of dexamethasone as adjuvant to 25 mL of 0.5% bupivacaine resulted in significantly longer-lasting sensory and motor blocks, postoperative analgesia, and a delayed time for first rescue analgesia without increasing undue adverse effects. Dexmedetomidine use is associated with more sedation as compared to dexamethasone.

Comparison of ropivacaine 0.5% with dexmedetomidine and clonidine as adjuvants in ultrasound-guided infraclavicular brachial plexus block for upper limb surgery

Background: The Institutional Ethics Committee and patients' informed written consent were obtained before this study was carried out in the Department of Anaesthesiology at Sardar Patel Medical College in Bikaner, Rajasthan. An established method for delivering anaesthesia and analgesia during upper limb surgery is brachial plexus block. For peripheral nerve blocks, ropivacaine, a long-acting amide with a safe cardiac profile, is chosen. It has been proven that different adjuncts may be added to LA solutions to boost their effectiveness and longevity while lowering the overall dose of LA utilised and minimising any systemic side effects. Our goal was to assess the effectiveness of adjuvants such as dexmedetomidine and clonidine in comparison to 0.5% ropivacaine in an infraclavicular block for upper limb surgery under USG guidance. Method: Fifty adult patients planned for elective upperlimb surgery with an infraclavicular brachial plexus block under USG guidance were included. All research participants were split into two groups at random. In groups D and C, respectively, dexmedetomidine and clonidine were used as adjuvants with 0.5% ropivacaine. Our main goal was to compare the postoperative analgesic duration in both research groups, as well as the onset and duration of sensory and motor block. Patients were monitored for any complications connected to the medicine and procedure while hemodynamic indicators were also compared. Results: Group D's sensory and motor block action initiation time was substantially quicker than that of group C's (p 0.001). When compared to Group C, Group D's sensory and motor block and postoperative analgesia durations were considerably longer (p value 0.001). Conclusion: Dexmedetomidine is a more effective adjuvant than clonidine when given during upper limb surgery with an infraclavicular block that is guided by a USG.

Comparison of ropivacaine 0.5% with dexmedetomidine and clonidine as adjuvants in ultrasound-guided infraclavicular brachial plexus block for upper limb surgery

Background: The Institutional Ethics Committee and patients' informed written consent were obtained before this study was carried out in the Department of Anaesthesiology at Sardar Patel Medical College in Bikaner, Rajasthan. An established method for delivering anaesthesia and analgesia during upper limb surgery is brachial plexus block. For peripheral nerve blocks, ropivacaine, a long-acting amide with a safe cardiac profile, is chosen. It has been proven that different adjuncts may be added to LA solutions to boost their effectiveness and longevity while lowering the overall dose of LA utilised and minimising any systemic side effects. Our goal was to assess the effectiveness of adjuvants such as dexmedetomidine and clonidine in comparison to 0.5% ropivacaine in an infraclavicular block for upper limb surgery under USG guidance. Method: Fifty adult patients planned for elective upperlimb surgery with an infraclavicular brachial plexus block under USG guidance were included. All research participants were split into two groups at random. In groups D and C, respectively, dexmedetomidine and clonidine were used as adjuvants with 0.5% ropivacaine. Our main goal was to compare the postoperative analgesic duration in both research groups, as well as the onset and duration of sensory and motor block. Patients were monitored for any complications connected to the medicine and procedure while hemodynamic indicators were also compared. Results: Group D's sensory and motor block action initiation time was substantially quicker than that of group C's (p 0.001). When compared to Group C, Group D's sensory and motor block and postoperative analgesia durations were considerably longer (p value 0.001). Conclusion: Dexmedetomidine is a more effective adjuvant than clonidine when given during upper limb surgery with an infraclavicular block that is guided by a USG.

Ultrasound-Guided Brachial Plexus Block by Costoclavicular Space Approach: A Narrative Review.

In recent years, ultrasound-guided costoclavicular brachial plexus block (CCB) has gained attention as a novel approach for brachial plexus nerve block. Human anatomy studies have identified the costoclavicular space as the area between the midpoint of the clavicle and the first rib. This space accommodates the brachial plexus, axillary arteries, and veins. Its superficial and fixed position makes it a promising option for infraclavicular brachial plexus blockage, providing a safe and reliable analgesic effect. CCB combines the benefits of real-time ultrasound visualization of the nerve block needle, avoidance of peripheral blood vessels, and targeted delivery of local anesthetics to the nerve. Consequently, it significantly reduces the associated complications of other classical approaches such as interscalene brachial plexus block (ISB), supraclavicular brachial plexus block (SCB), lateral sagittal infraclavicular brachial plexus block (LS-ICB), and axillary brachial plexus block. These complications include phrenic paralysis, incomplete brachial plexus block, and pneumothorax. This narrative review examines the literature on brachial plexus block in the costoclavicular space, discussing the anatomical position, the procedure, clinical indications, choice of local anesthetic concentration and volume, and continuous nerve block of CCB. The aim is to provide a basis for future clinical practice and enhanced safety.

A Randomized Controlled Trial to Compare the Efficacy of Single versus Triple Injection Technique for Ultrasound-Guided Infraclavicular Block in Upper Limb Surgeries.

The ultrasound-guided infraclavicular brachial plexus block by triple-point injection method was aimed at blocking the three individual cords in the infraclavicular region.Recently, a single-point injection method which does not require visualization of cords to produce nerve block has been introduced. This study compared the block onset time, performance time, patient's satisfaction, and complications between the ultrasound guided triple-point injection and single-point injection methods. This randomized controlled trial was conducted in a tertiary care hospital. Sixty patients were divided into two groups - Group S: 30 patients received single-point injection method of infraclavicular block. Group T: 30 patients received triple-point injection method of infraclavicular block. Drugs used were 0.5% ropivacaine with 8 mg dexamethasone. The sensory onset time was significantly longer in Group S (11.13 ±1.83 min) than Group T (6.20 ±1.19min). No statistically significant difference was found between the two groups regarding mean motor onset time. The composite sensorimotor onset time was similar between the groups. The mean time to perform the block was significantly lesser in Group S (1.35 ±0.38 min) when compared to group T (3.44 ±0.61min). The patient satisfaction score, conversion to general anesthesia and complications were not significant among the two groups. We concluded that single-point injection method had a shorter performance time and similar total onset time with less procedural complications compared with triple point injection method.

Dexamethasone as an adjuvant to local anesthetic mixture in brachial plexus block: A prospective randomized double-blind controlled trial

Introduction: Peripheral neural blockade is now a well-accepted component of comprehensive anesthetic care. Many adjuvants such as dexmedetomidine, clonidine, opioids, ketamine, and midazolam and corticosteroids have been used; however, still the search for ideal adjuvant is in process. The purpose of this study was to investigate whether addition of 8 mg dexamethasone to local anesthetic solution for brachial plexus block would prolong the period of postoperative analgesia. Materials and Methods: This was a prospective double-blind randomized controlled trial. Forty patients between the age of 20 and 65 years, of either sex of the American Society of Anesthesiologists Grade I-III, who were undergoing upper limb surgery, were selected to study the quality of brachial plexus block and duration of postoperative analgesia produced by addition of dexamethasone to local anesthetic solution versus plain local anesthetic solution in the infraclavicular brachial plexus block. Results: Demographic parameters such as age, weight, height, and body mass index were comparable between two groups with P > 0.05. We also observed that onset of sensory and motor block was earlier in Group I, and duration of motor and sensory block was more in Group I. There was a less requirement of postoperative analgesics. Furthermore, the incidence of postoperative complications was less in Group I compared to Group II. Conclusion: We conclude that addition of dexamethasone to local anesthetic solution for brachial plexus block sets the sensory block early, increases the duration of sensory block without any side effect, provides improved patient comfort, effective pain relief, and decreases the requirement of postoperative supplementary analgesic.

Total Wrist Arthrodesis: An Update on Indications, Technique and Outcomes.

Painful end-stage wrist osteoarthritis (OA) unresponsive to conservative treatment is frequently managed with total wrist arthrodesis (TWA), which might render pain alleviation and ameliorate function, pain, and grip strength. Usual indications for TWA include inflammatory arthritis, idiopathic degenerative OA and posttraumatic OA, Kienböck's illness, brachial plexus palsy, cerebral paralysis, infraclavicular brachial plexus blocks and other spastic and contracture base illnesses, scapholunate advanced collapse, scaphoid nonunion advanced collapse, and failure of other surgical techniques such as after failed total wrist arthroplasty, four-corner fusion, proximal row carpectomy and severe ligament injuries (this procedure iscarried out when all other treatment alternatives have failed to control the individual's symptoms). TWA is commonly carried out with a dorsal plate fixed from the distal radius to the third metacarpal. However, other surgical procedures have been reported, including intramedullary fixation and new implants that do not cross the third carpometacarpal joint or some procedures without utilizing hardware for example using a vascularized fibular grafting In individuals with rheumatoid arthritis. TWA has been shown to give persistent and painless stability for 20 years or more. The rate of adverse events for TWA ranges from 0.1% to 6.1%, though some authors have published that it can be as high as 27%. The most common adverse events are tendon ruptures, peri-implant fractures of the third metacarpal, the need for hardware removal, and constant pain at the third carpometacarpal joint. In idiopathic degenerative OA, the reoperation rate following TWA has been reported as high as 63%. While TWA can render foreseeable pain alleviation and ameliorate function, orthopedic surgeons should remember that this surgical technique is not without its risks and that the accessibility of many surgical procedures requires orthopedic surgeons to scrupulously contemplate the risks and benefits of each alternative for the individual in front of them.

Clonidine as an Adjuvant to Local Anaesthetic in Infraclavicular Brachial Plexus Block: A Randomised Clinical Trial

Introduction: Brachial plexus blocks are routinely performed to provide anaesthesia and analgesia for upper limb orthopaedic surgeries. Various adjuvants are being added to local anaesthetic solution to prolong the duration of sensory and motor blockade to ensure successful completion of long duration surgeries with adequate postoperative analgesia. Clonidine is used in varying dosages as adjuvant for peripheral nerve block. Aim: To study different dosages of clonidine when used as an adjuvant in infraclavicular approach to brachial plexus block. Materials and Methods: The randomised double-blind clinical study enrolled 60 American Society of Anaesthesiologists (ASA) I and II patients, between ages of 18-60 years, undergoing elective forearm orthopaedic surgery, lasting more than one hour. Based on the dose of clonidine added, the patients were distributed to group I (75 µg); group II (100 µg) and group III (150 µg). They were compared with regard to onset and duration of sensory and motor blockade, haemodynamic parameters, quality of sedation and side-effects. The results were analysed using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: Demographic profile was comparable between the study groups. The onset of sensory and motor duration was faster in group III (5.8±1.65 minutes; 10.08±0.98 minutes). Also, the duration of sensory and motor blockade was highest in group III (11.02±2.33 hours; 10.44±1.45 hours). Patients in group III had significantly higher level of sedation in comparison to other groups. Conclusion: Clonidine in a dose of 150 µg provides significantly longer duration of sensory and motor blockade without any adverse haemodynamic outcomes.

Effects of catheter orifice configuration (triple-hole versus end-hole) in continuous infraclavicular brachial plexus block on analgesia after upper limb surgery.

The configuration of a nerve block catheter may affect the local anesthetic spread in epidural analgesia and continuous peripheral nerve blocks. This prospective and randomized study aims to compare the multi-orifice nerve block catheter with an end-hole catheter in ultrasound-guided continuous infraclavicular brachial plexus block (BPB) in terms of providing postoperative analgesia for the orthopedic upper limb surgery below the shoulder. The primary outcome measure was mean pain scores. Secondary outcome measures were the consumption of rescue analgesic and the amount of local anesthetics delivered by a Patient-Controlled Analgesia (PCA) device. A total of 58 adult patients who underwent orthopedic upper limb surgery below the shoulder were randomly assigned into two groups: group end-hole catheter (EHC) (n=31) and group multi-orifice catheter (MOC) (n=27). All patients received a single-shot infraclavicular BPB using 100 mg lidocaine 2% and 75 mg bupivacaine 0.5% administrated through a Tuohy needle. Then, a multi-orifice (triple-hole) nerve catheter was placed in the group MOC and an end-hole (one-hole) catheter in the group EHC at the same location. Bupivacaine 0.125% was infused through the catheters via PCA (infusion rate: 2 mlh-1, automated regular bolus: 5 mlh-1, patient-controlled bolus: 3 ml, lock-out time: 1 hour, 4 hours limit: 40 ml). Pain intensity was evaluated using a visual analogue scale (VAS). Mean VAS scores were higher in group EHC than group MOC in the first postoperative day (p=0.001). Mean rescue analgesic consumption, the number of bolus demand on PCA, PCA bolus demand dose, and total PCA dose were higher in group EHC than group MOC during the first postoperative day (p<0.05). It is concluded that the use of MHC is more effective than EHC for continuous infraclavicular brachial plexus blocks in providing postoperative pain relief during the first 24 hours.

Comparison of para-vascular supraclavicular brachial plexus block and costo-clavicular approach of infraclavicular brachial plexus block in providing surgical anesthesia for below elbow surgery: a randomized, single blind study

BackgroundWith better precision of the brachial plexus block (BPB) under real-time ultrasound guidance, supraclavicular BPB (SC-BPB) and infraclavicular BPB (IC-BPB) are being used interchangeably for upper limb surgeries. However, the number of anesthesiologists practicing SC-BPB is much more than those practicing IC-BPB.Many studies have compared SC-BPB and IC-BPB, but a study comparing the para-vascular approach of SC-BPB and costo-clavicular approach of IC-BPB is missing. This prospective study compared the costo-clavicular approach of IC-BPB with the para-vascular approach of SC-BPB. A total of 80 patients (40 in each group), aged 18–65 years, belonging to ASA class I and II and undergoing hand, wrist and forearm surgery were randomly allocated to group S (receiving SC-BPB) and group I (receiving IC-BPB). The two groups were compared with respect to the block success rate, block performance time, time taken to achieve surgical anesthesia, efficacy, and safety in providing surgical anesthesia for below elbow upper limb surgeries.ResultsBlock success was significantly higher in the IC-BPB (100%) vs SC-BPB (92.5%), P value 0.03. Scan time was significantly more in the SC-BPB, P value 0.001. The block performance time was comparable; time to achieve surgical anesthesia was significantly longer in the IC-BPB, P value 0.001. Time for first rescue analgesia was longer in the IC-BPB, P value 0. 001. The number of patients requiring intraoperative sedation was comparable, P value 0.99.ConclusionsIC-BPB has greater success rate in providing surgical anesthesia in below elbow surgeries and provides longer postoperative analgesia.

Comparison of the efficacy of two doses of dexmedetomidine as an adjunct to levobupivacaine in infraclavicular brachial plexus block: prospective double-blinded randomized controlled trial

BackgroundThis prospective, double-blind, randomized, controlled trial compared the efficacy of two dexmedetomidine doses (50 and 100-μg) combined with levobupivacaine on sensory block duration in infraclavicular brachial plexus block. We hypothesized that perineural dexmedetomidine would extend sensory block duration dose-dependently.MethodsThe study included 60 patients aged 20 to 60 years of both sex with an ASA I/II undergoing forearm and hand surgery. The patients were randomly assigned into three equal groups (n = 20) for ultrasound-guided infraclavicular brachial plexus block. The L group received 35-mL 0.5% levobupivacaine plus normal saline, the LD50 group received 35-mL 0.5% levobupivacaine plus 50-μg dexmedetomidine, and the LD100 group received 35-mL 0.5% levobupivacaine plus 100-μg dexmedetomidine. Patients were investigated for onset and duration of sensory blockade, time to first postoperative rescue analgesia, and the total 24-h postoperative morphine requirement.ResultsThe LD100 group had a longer sensory block duration (15.55 ± 1.1 h; 95% confidence interval (CI), 15.04–16.06) than the LD50 group (12.8 ± 1.2 h; 95% CI, 12.24–13.36 h) (p < 0.001) or the L group (9.95 ± 1.05 h; 95% CI, 9.46–10.44 h) (p < 0.001). The LD100 group took longer to request postoperative rescue analgesia and required fewer postoperative morphine doses than the LD50 and L groups (P < 0.001).ConclusionsSensory block duration was longer with perineural 100-μg dexmedetomidine as an adjunct to levobupivacaine than with 50-μg dexmedetomidine.Trial registrationThis study was approved by the Ethics Committee of Aswan University Hospital (approval number: aswu/125/4/17) (date of registration: 04/04/2017). Furthermore, the trial was retrospectively registered at ClinicalTrial.gov (NCT04729868) with a verification date of January 2021.

Bilateral infraclavicular brachial plexus nerve blocks in an ambulatory surgery center

The approach for upper extremity surgery brachial plexus blocks depends on the specific nature of the surgery. Interscalene and supraclavicular brachial plexus blocks can cause phrenic nerve palsy. Our aim was to explore the safety of bilateral parasagittal infraclavicular brachial plexus blocks (BPBBs) in an outpatient surgery center. Identical BPBBs were performed in two patients with 20 mL of 0.25% bupivacaine. Neither patient developed respiratory or cardiovascular distress. Brachial plexus blocks on multiple locations are infrequently employed for fear of phrenic nerve paresis. However, given both patients’ success, bilateral parasagittal infraclavicular brachial plexus blocks may provide a safe approach. Keywords: Nerve block, brachial plexus blocks, phrenic nerve, anesthesia, pain