Infraclavicular Group Research Articles

Cartridge-Based Nucleic Acid Amplification Test Compared to Fine Needle Aspiration Cytology in Suspected Cases of Tubercular Lymphadenitis (the Indian Experience)

INTRODUCTION: Diagnosis of tubercular lymphadenitis is daunting as there are varied clinical presentations and no single confirmatory gold standard test. Cartridge-based nucleic acid amplification test (CBNAAT) of the lymph node is a rapid molecular diagnostic test for simultaneously detecting tuberculosis (TB) and rifampicin resistance. AIM: To evaluate the performance of the CBNAAT test for detecting M. tuberculosis in lymph node specimens compared to fine needle aspiration cytology (FNAC). MATERIALS AND METHODS: The study was conducted in a rural tertiary care hospital in central India. A total of 180 patients clinically suspected of tubercular lymphadenitis were included. The male-to-female ratio was 1:1.3. The average age was 33.3 years. The age group 21–40 years had the highest number of cases. The most common complaints among the patients were fever (29.4%), followed by loss of appetite (9.5%), weight loss (9.5%), and cough (6.6%). However, most patients presented to the hospital with only lymphadenopathy (44.4%). The most common site involved was the anterior cervical lymph node (78.8%), followed by the axillary group (10.5%), submandibular (2.8%), inguinal (2.8%), supraclavicular (2.2%), submental (1.7%) and infraclavicular (1.1%) group of lymph nodes. The patients were subjected to both FNAC and CBNAAT testing. Results were reported as positive or negative for M. tuberculosis as CBNAAT gives a semiquantitative estimate of the concentration of bacilli. Rifampicin resistance results were reported as detected or not detected. RESULTS: Cytological examination of the lymph node aspirates revealed that most were tubercular lymphadenitis cases. Cytomorphological analysis of the cases of tubercular lymphadenitis revealed Type 6 (tubercular abscess) as the predominant pattern. CBNAAT testing detected 26 cases of M. tuberculosis and three cases of rifampicin resistance. The study reported a specificity of 92.92% and low sensitivity of 26.86% of combined FNAC and CBNAAT is much higher compared to only CBNAAT. CONCLUSION: CBNAAT, along with FNAC, is a valuable addition in first-line investigations of tubercular lymphadenitis to make a timely diagnosis.

Supraclavicular versus infraclavicular brachial plexus block in upper limb orthopaedic surgery: a systematic review and meta-analysis of randomised controlled trials.

Clavicular brachial plexus blocks are a popular method to provide analgesia in upper limb surgery. Two common approaches include the infraclavicular (IC) and supraclavicular (SC) blocks. These two techniques have been compared previously; however, it is still being determined from the current literature whether one should be favoured. A search was performed on the following databases: Ovid Medline, EMBASE and the Web of Science from inception until 30.04.2023. All RCTs comparing SC and IC approaches in upper limb orthopaedic surgery were included. The primary outcome was block success rate. Eighteen RCTs comprising 1389 patients were included. The success rate of IC blocks was higher than SC blocks, odds ratio 0.61 (95% CI 0.41-0.91, p = 0.01). A small number of studies reported on secondary outcomes. A reduced rate of Horner's syndrome was observed in the IC group. Otherwise, no difference was noted between the approaches in terms of procedure time, sensory onset time, patient satisfaction, pain and vascular puncture. IC blocks demonstrate a higher success rate over SC blocks. Across all studies a large variance in outcome reporting and definitions was observed. Future studies should conform to an agreed definition set to facilitate comparison.

Ultrasound-Guided Subclavian Vein Catheterization: Contrasting Supraclavicular and Infraclavicular Approaches for Enhanced Procedural Precision.

Background Ultrasound-guided subclavian vein catheterization is crucial for central venous access, but the choice between the supraclavicular and infraclavicular approaches lacks comprehensive comparison. This study addresses this gap by conducting a prospective observational analysis of both techniques. The supraclavicular method accesses the vein from above the clavicle while the infraclavicular targets it below. Our model-driven approach aims to elucidate the procedural nuances, success rates, and complications associated with each method. The findings intend to equip clinicians with evidence-based insights, facilitating informed decision-making for improved procedural outcomes in ultrasound-guided subclavian vein catheterization. Aim and objective This study aims to comprehensively compare the supraclavicular and infraclavicular approaches in ultrasound-guided subclavian vein catheterization, evaluating the procedural minutiae, potential advantages, and challenges associated with each technique. Employing a prospective observational methodology, our objective is to provide evidence-based insights for approaches in ultrasound-guided subclavian vein catheterization, evaluating procedural nuances, success rates, and complications during the procedure. Methods In this prospective investigation, 276 patients aged between 20 and 55 years were randomly assigned to two groups: 143 patients in the supraclavicular group and 133 patients in the infraclavicular group. Specifically, patients admitted for elective surgery necessitating postoperative ICU care were considered. The study assessed various variables, including success rate, time required for venous visualization, venous puncture, catheterization, total procedure duration, and incidence of mechanical complications, to facilitate group comparisons. Results The mean procedural time was shorter in the supraclavicular group compared to the infraclavicular group, with durations of 2 minutes and 2 seconds versus 3 minutes and 40 seconds, respectively (95% CI). This difference was statistically significant. Similarly, the mean durations for venous visualization, venous puncture, and venous catheterization were also shorter in the supraclavicular group, and these differences were statistically significant. Both groups achieved a 100% success rate, with the first attempt success rate being higher in the supraclavicular subclavian vein group. Conclusion The findings of this study demonstrate a statistically significant advantage in favor of the supraclavicular approach for ultrasound-guided subclavian vein catheterization. The shorter mean procedural time, as well as durations for venous visualization, puncture, and catheterization, emphasize the efficiency of the supraclavicular technique. The consistently achieved 100% success rate, coupled with a higher first-attempt success rate, further underscores the proficiency of the supraclavicular subclavian vein group. These results collectively suggest that the supraclavicular approach is not only time-efficient but also superior in terms of successful central line placement, making it a promising choice for both emergency and critical care settings.

Subclavian Vein Cannulation via Supraclavicular or Infraclavicular Route Which is Better? A Prospective Randomized Controlled Trial.

The subclavian vein is frequently cannulated using ultrasound. There are two techniques of subclavian vein catheterization (SVC): Supraclavicular (SC) and infraclavicular (IC). Though the IC route is often preferred, the SC approach offers several distinct advantages. This study was planned to compare the technique of SVC using SC and IC approaches in terms of catheterization technique and complications in elective surgeries in adults. Sixty American Society of Anesthesiologists (ASA) 1, 2, or 3 adult patients posted for elective surgeries under general anesthesia were recruited. Patients were divided into SC or IC groups randomly. Right-sided subclavian vein was cannulated in both the groups (n = 30). Visualization time, Likert scale, subclavian vein diameter, skin-to-subclavian vein depth, number of attempts, puncture time, ease of guidewire insertion, catheter insertion time, and total procedural time were observed. A comparison of complications for each approach was noted. Total procedural time, time to visualization of the subclavian vein, and puncture time was lower for group SC and higher for group IC. Catheter insertion time was higher with the IC approach than with the SC approach. Better ultrasound view scores were seen in group SC than in group IC. The first attempt success rate was higher in group SC than in group IC. Comparatively, lower complications both during and after the procedure were noted in the SC approach than the IC approach. Ultrasonography (USG) guidance guided SC approach to access the subclavian vein is quicker, relatively secure, and a better technique than the IC approach. Additionally, the SC approach is associated with comparatively fewer immediate and delayed complications. Jaiswal P, Saini S, Chhabra PH. Subclavian Vein Cannulation via Supraclavicular or Infraclavicular Route Which is Better? A Prospective Randomized Controlled Trial. Indian J Crit Care Med 2024;28(4):375-380.

Comparative Evaluation of Supraclavicular and Infraclavicular Approaches to Brachial Plexus Block for Upper Limb Surgeries Using Ultrasonography

Background and Aim: Brachial plexus blocks when administered adroitly offer numerous benefits over general anaesthesia for upper limb surgeries. It is especially beneficial in patients with substantial comorbid conditions such as diseases involving the respiratory and cardiovascular system, life-threatening obesity, and those with an anticipated difficult airway. Out of its many approaches, we aim to compare and assess the Supraclavicular and Infraclavicular techniques utilising ultrasonography. Methods: Sixty consenting ASA I–II patients, aged 18–65 years, scheduled for elective upper limb surgery were randomly divided into two groups of 30 each: Supraclavicular (S) and Infraclavicular block Groups (I). Blocks were performed under ultrasound-guidance. The quality of the block intra-operatively, patient satisfaction post-operatively, duration of the sensory & motor block, and complications were observed. Results: Demographics, number of attempts, mean pain score felt during the administration of the block, mean duration of motor and sensory blockade and incidence of complications were all comparable between the two groups & statistically not significant. However, at 5 and 10 minutes after the execution of the block, the Infraclavicular group showed a higher level of blockade, indicating that the onset of action of the block was significantly quicker. Conclusion: Time taken to perform & rapidity of onset were more in the Infraclavicular block with no difference in adequacy of both blocks at 30 minutes.

Supraclavicular versus infraclavicular approach for ultrasound-guided right subclavian venous catheterisation: a randomised controlled non-inferiority trial.

Infraclavicular and supraclavicular approaches are used for subclavian venous catheterisation. We hypothesised that the supraclavicular approach is non-inferior to the infraclavicular approach in terms of safety during ultrasound-guided right subclavian venous catheterisation. We randomly allocated 401 neurosurgical patients undergoing ultrasound-guided right subclavian venous catheterisation into supraclavicular (n = 200) and infraclavicular (n = 201) groups. We assessed catheterisation-related complications (primary outcome measure) including catheter misplacement and mechanical complications (arterial puncture, haematoma formation, pneumothorax and haemothorax). We also recorded catheterisation success rates and time required for venous puncture and catheterisation. The number (proportion) of patients with catheterisation-related complications was six (3.0%) in the supraclavicular group and 27 (13.4%) in the infraclavicular group, mean difference (95%CI) -10.4% (-15.7 to -5.1%), p < 0.001, with a significant difference also seen for catheter misplacement. Except for a shorter time (median (IQR [range]) required for venous puncture in the supraclavicular group, being 9 (6-20 [2-138]) vs. 13 (8-20 [3-99]) s, the incidence of mechanical complications and other catheterisation characteristics were similar between the two groups. We recommend the supraclavicular approach for ultrasound-guided right subclavian venous catheterisation.

Comparative efficacy of supraclavicular versus infraclavicular approach of subclavian vein cannulation under ultrasound guidance: A randomised clinical trial.

Background and Aims:Subclavian vein (SCV) cannulation can be performed using either supraclavicular (SC) or infraclavicular (IC) long-axis approach under ultrasound guidance (USG). However, their relative efficacy remains debatable. The aim of this study was to compare these two approaches in terms of safety, ease, success rate, and record the incidence of complications.Methods:We studied 90 adult patients distributed into two groups of 45 each. Data regarding the time taken for first venous puncture, the time required for inserting the catheter, the total number of attempts, the incidence of guidewire misplacement, and other mechanical complications were compared using Student's t-test for quantitative data and Chi-square test for qualitative value.Results:Mean puncture time was significantly lesser in group SC than IC (P-value < 0.001). Mean catheter insertion time taken was also significantly less in group SC than IC (P-value = 0.003). The first attempt rate was higher in group SC than IC (P = 0.013). Guidewire misplacement was seen in the IC group, P = 0.001. No pneumothorax, haemothorax, or arterial puncture were noted in our study in any of the groups.Conclusion:We conclude that for right-sided SCV cannulation using USG in the long axis, the SC approach is superior to the IC approach in terms of overall ease of cannulation. It was associated with a relatively shorter procedure time, higher success rate in the first attempt, lesser incidence of guidewire misplacement, and other complications. It should be considered as an alternative approach to the IC approach in patients requiring central line insertion.

Comparison Between Supraclavicular and Infraclavicular Approach in Subclavian Vein Catheterization in Tertiary Center of Nepal

Introduction: Central vein catheterization can be introduced in subclavian vein (SCV), internal jugular vein or femoral vein for volume resuscitation and invasive monitoring technique. Due to anatomical advantage and lesser risk of infection subclavian vein is preferred. Either supraclavicular (SC) or infraclavicular (IC) approach could be used for subclavian vein catheterization. The aim of the study was to compare SC and IC approach in ease of catheterization of SCV and record the complications present if any.&#x0D; Methods and materials: This was a hospital based comparative, interventional study conducted from November 2016 to October 2017 in Operation Theater in Bir Hospital. In this study, 70 patients for elective surgical cases meeting the inclusion criteria were randomly enrolled. Then samples were equally divided by lottery into either supraclavicular or infraclavicular approach groups. The Access time, cannulation success rate, attempts made for successful cannulation of vein, easy insertion of catheter and guide wire, approximate inserted length of catheter and associated complications in both groups were recorded. Data was entered in statistical software SPSS 16. Chi-square test was used. P value &lt; 0.05 was considered significant.&#x0D; Results: The mean access time in group SC for SCV catheterization was 2.12 ± 0.81 min compared to 2.83 ± 0.99 min in group IC (p-value= 0.002). The overall success rate in catheterization of the right SCV using SC approach (34 / 35) was better as compared with group IC (33 / 35) using IC approach. First successful attempt in the SC group was 74.28% as compared with 57.14% in the IC group.&#x0D; Conclusion: The SC approach of SCV catheterization can be considered alternative to IC approach in terms of landmark accessibility, success rate and rate of complications.

Comparison of the effects of interscalene, supraclavicular and infraclavicular peripheral nerve blockades on perfusion index

Background: The perfusion index (PI) is a non-invasive method that measures the monitoring and success of peripheral nerve blocks in regional anesthesia. The perfusion index (PI) is an objective non-invasive method of measuring and monitoring the success of peripheral nerve blocks. We compare the effects of interscalene, supraclavicular and infraclavicular blocks on the perfusion index, with the aim being to contribute to the decision-making process regarding the type of block to be selected for surgeries in which increased perfusion is important. Methods: Included in the study were 60 patients aged between 18 and 60 years with an ASA (American Society of Anesthesiologists) I-II risk rating who were scheduled for upper extremity surgery. An equal number of patients were applied supraclavicular, interscalene and infraclavicular blockades, and the PI was measured non-invasively using a pulse-oximetry probe on the fingers on the same and opposite side of blockade at the beginning, at the 10 th , 20 th and 30 th minutes, postoperatively and in the post-anesthetic care unit (PACU). Results: After a successful blockade of brachial plexus in all patients, a statistically significant increase in PI values was detected. Aside from the initial values, the mean rate of change in PI was significantly higher in the interscalene group than the supraclavicular and infraclavicular groups (p < 0.001). Conclusion: PI can be used as a non-invasive monitoring method for the determination of the success of a brachial plexus blockade. Based on the results of the present study, an interscalene blockade may be preferred especially for surgeries in which an increase in tissue perfusion is desired due to its perfusion-enhancing properties when compared to supraclavicular and infraclavicular blocks.

Infraclavicular Thoracic Outlet Decompression Compared to Supraclavicular Thoracic Outlet Decompression for the Management of Venous Thoracic Outlet Syndrome

The treatment of venous thoracic outlet syndrome (VTOS) requires surgical decompression often combined with catheter-directed thrombolysis and venoplasty. Surgical optionsinclude transaxillary, supraclavicular, or infraclavicular approaches to first rib resection. The optimal method, however, has yet to be defined. The purpose of this study is to compare the outcomes of patients who underwent infraclavicular versus supraclavicular surgical decompression for VTOS. A retrospective review of patients who underwent surgical management for VTOS from December 2010 to November 2017 was performed. During the study period, supraclavicular and infraclavicular approaches were chosen according to surgeon preference. Patient demographics, pre- and postdecompression interventions, perioperative outcomes for each group of patients were analyzed. Thirty patients underwent surgical management of VTOS, of which 15 (50%) underwent infraclavicular decompression and 15 (50%) supraclavicular decompression. The mean age of patients was 32.1±13.6years and 80% were male. Twenty-six patients (86.7%) presented with thrombotic VTOS. Acute axillosubclavian vein thrombosis was present in 20 (76.9%) of these patients, 10 patients in each group. Subacute or chronic thrombosis was encountered in the remaining 6 (23%) patients, 2 patients in the infraclavicular group and 4 patients in the supraclavicular group. Preoperative thrombolysis was utilized in 7 (46.7%) and 6 (40%) patients in the infraclavicular and supraclavicular groups, respectively (P=1.00). Patients without postdecompression venography were removed from analysis and included 1 patient in the infraclavicular group and 5 patients in the supraclavicular group. Initial postdecompression venogram, prior to any endovascular intervention, demonstrated a residual axillosubclavian vein stenosis of greater than 50% in 6 (42.9%) patients in the infraclavicular decompression group and 7 (70%) patients in the supraclavicular decompression group (P=0.24). Crossing the stenosis after surgical decompression was more easily accomplished in the infraclavicular group, 14 (100%) versus 5 (50%), (P=0.01). Following endovascular venoplasty, calculated residual stenosis greater than 50% was found in 0 (0%) and 3 (30%) patients in the infraclavicular and supraclavicular approaches, respectively (P=0.047). Infraclavicular thoracic outlet decompression was associated with fewer patients with postoperative symptoms, 0 of 15 (0%) versus 8 of 15 (53.3%), (P=0.0022), and infraclavicular thoracic outlet decompression demonstrated improved patency, 15 of 15 (100%) versus 8 of 15 (53.3%), (P=0.028) at a mean combined follow-up of 8.47±10.8months. Infraclavicular thoracic outlet decompression for the surgical management of VTOS was associated with fewer postoperative symptoms and improved axillosubclavian vein patency compared to the supraclavicular approach. Prospective analysis is warranted to determine long-term outcomes following infraclavicular decompression.

Long-Term Quality of Life Comparison between Supraclavicular and Infraclavicular Rib Resection in Patients with vTOS

Rib resection in venous thoracic outlet syndrome (vTOS) may be approached via a transaxillary, supraclavicular, or infraclavicular approach based on surgeon preference. The purpose of this study was to evaluate long-term postoperative quality of life function after surgery for vTOS and to determine if there were long-term patency differences associated with the surgical approach or whether prophylactic postoperative venography was performed. All patients with vTOS undergoing rib resection at a single institution were retrospectively reviewed. In 2012, we switched our approach to infraclavicular with postoperative venogram performed within 2 weeks of rib resection. Clinical records and imaging results were tabulated, and postoperative outcomes, complications, and long-term symptom follow up via the disabilities of the arm, shoulder, and hand score surveys. The disabilities of the arm, shoulder, and hand score ranges from 0 to 100 with lower numbers indicating better functional status (100=worst). During the 19-year study period, we performed 109 rib resections in patients with vTOS (mean age, 29.8years). From 2000 to 2012, 54 patients were approached via a supraclavicular approach, and from 2012 to 2018, 55 patients were approached via an infraclavicular approach. There was a significant decrease in the number of complications in the infraclavicular cohort compared with the supraclavicular group. There was no difference in patency between the 2 groups even with a higher rate of postoperative venogram in the infraclavicular cohort. There was no difference in long-term the disabilities of the arm, shoulder, and hand scores. There was an increased rate of complications in the supraclavicular cohort as compared with the infraclavicular group (P<0.05). The infraclavicular approach in patients with vTOS is associated with a lower rate of complications, but long-term quality of life outcomes and patency are not different between groups.

Comparison of Supraclavicular, Infraclavicular, and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Upper Limb Surgeries: A Retrospective Analysis of 182 Blocks

Background: Supraclavicular (SCL), infraclavicular (ICL), and axillary (AX) brachial plexus nerve blocks are used for the upper extremity. Regional nerve blocks should be considered for their beneficial effects and less risk of complications. Objectives: The aim of this study was to conduct a retrospective evaluation of our experiences in ultrasound (US)-guided techniques of the SCL-ICL and AX approaches for brachial plexus block (BPB) in producing high-quality surgical anesthesia for operations below the shoulder. Methods: The records of 182 American Society of Anesthesiologists (ASA) grade I–III patients undergoing upper extremity and vascular surgeries under BPB by US guidance were evaluated. SCL, AX, and ICL approaches were used. A linear US probe was used for all patients. Data pertaining to demographic characteristics, ASA physical status, underlying diseases, block type, time between the block performance and the start of the operation, duration of the operation, type of surgeries, needle length, toxicity findings, postoperative complications, and success rates were assessed. Results: Demographic data were found to be similar with no statistically significant differences between the study groups (p > 0.05). The three groups were also similar in ASA physical status, type of surgery, the experience of the anesthesiologists who performed the blocks, the time between the end of the block performance and the start of the operation, and the quality of the surgical anesthesia. Transient Horner’s syndrome was detected in 3 patients in the SCL group and in 1 patient in the ICL group. Conclusions: All three approaches can be used for US-guided BPB with adequate quality of surgical anesthesia.

Cosmetic outcomes and quality of life in children with cardiac implantable electronic devices.

Axillary implant location is an alternative implant location in patients for cardiac implantable electronic devices (CIEDs) for the purposes of improved cosmetic outcome. The impact from the patient's perspective is unknown. The purpose of this study was to compare scar perception scores and quality of life (QOL) in pediatric patients with axillary CIED implant location versus the standard infraclavicular approach. This is a multicenter prospective study conducted at eight pediatric centers and it includes patients aged from 8 to 18years with a CIED. Patients with prior sternotomy were excluded. Scar perception and QOL outcomes were compared between the infraclavicular and axillary implant locations. A total of 141 patients (83 implantable cardioverter defibrillator [ICD]/58 pacemakers) were included, 55 with an axillary device and 86 with an infraclavicular device. Patients with an ICD in the axillary position had better perception of scar appearance and consciousness. Patients in the axillary group reported, on average, a total Pediatric QOL Inventory score that was 6 (1, 11) units higher than the infraclavicular group, after adjusting for sex and race (P=0.02). QOL is significantly improved in axillary in comparison to the infraclavicular CIED position, regardless of device type. Scar perception is improved in patients with ICD in the axillary position.

Supraclavicular versus Infraclavicular Subclavian Vein Catheterization in Coronary Artery Bypass Graft Surgery

Background: Percutaneous central vein catheterization is one of the most invasive procedures commonly performed by anesthesiologists during cardiac surgery. Objectives: The aim of this study was to investigate the complications of supraclavicular (SC) versus infraclavicular (IC) approaches for subclavian vein catheterization during coronary artery bypass graft surgery. Materials and Methods: Between October 2014 and June 2015, this prospective, randomized clinical trial was performed in 280 patients. The patients were randomly cannulated by SC or IC approach. The success and complication rates were compared for the two approaches. The outcome of this study was analyzed using SPSS software and through Chi-square test. Results: In the first attempt of catheterization, the success rate in SC (78.6%) group was lower than IC (94.3%) group (P = 0.0001). The overall success rate in two attempts were 136 (97.1%) in the IC approach and 132 (94.3%) in the SC approach (P = 0.238). In 12 (4.3%) patients, subclavian catheterizations were failed after two attempts in both approaches. In 28 (10%) patients, hematoma at puncture site occurred, 1 (0.7%) in IC approach, and 27 (19.3%) in SC approach (P = 0.0001). The differences in other complications on two approaches were statistically insignificant. Conclusions: Compared with the SC approach, the IC approach resulted in fewer hematomas at puncture sites. The incidence of overall cannulation failure and other complications were similar on both approaches.

A randomised comparative evaluation of supraclavicular and infraclavicular approaches to brachial plexus block for upper limb surgeries using both ultrasound and nerve stimulator.

Background and Aims:The supraclavicular and infraclavicular brachial plexus blocks have a similar distribution of anaesthesia, and both can be used effectively for surgeries of the upper limb. This study aimed to compare the supraclavicular and infraclavicular approaches of brachial plexus blocks, guided by ultrasound and neurostimulation.Methods:Sixty adult patients scheduled for elective upper limb surgery of the elbow and/or below were randomly divided into two groups: infraclavicular Group (I) and supraclavicular Group (S). All the blocks were performed with the aid of ultrasound-guided nerve stimulator confirmation. The two groups were compared with respect to block performance time, onset of sensory and motor blockade, readiness for surgery, success rate and complications. The statistical analysis was performed with Student t-test and Chi-square test.Results:The block performance time for the infraclavicular group was 9.57 ± 3.19 min, whereas for supraclavicular group, it was 11.53 ± 2.90 min with similar success rates (93.3%). Onset of sensory blockade was achieved earlier (6.43 ± 2.61 min) in Group I than Group S (8.45 ± 2.87 min, P = 0.006). The onset of motor blockade was similar in Group I (7.32 ± 2.90 min) and Group S (8.68 ± 3.50 min, P = 0.121). The patient satisfaction was similar in both the groups. One patient had a pneumothorax, three patients developed Horner syndrome and another had clinically symptomatic diaphragmatic paresis in Group S.Conclusion: The infraclavicular block is more rapidly executed compared to supraclavicular block with similar success rates and fewer complications in the presence of ultrasound and nerve stimulator and hence should be preferred.

Comparative effectiveness of infraclavicular and supraclavicular perineural catheters for ultrasound-guided through-the-catheter bolus anesthesia.

Using a through-the-needle local anesthetic bolus technique, ultrasound-guided infraclavicular perineural catheters have been shown to provide greater analgesia compared to supraclavicular catheters. A through-the-catheter bolus technique, which arguably "tests" the anesthetic efficacy of the catheter before initiating an infusion, has been validated for infraclavicular catheters but not supraclavicular catheters. This study investigated the through-the-catheter bolus technique for supraclavicular catheters and tested the hypothesis that infraclavicular catheters provide faster onset of brachial plexus anesthesia. Preoperatively, patients were randomly assigned to receive either a supraclavicular or an infraclavicular catheter using an ultrasound-guided nonstimulating catheter insertion technique with a mepivacaine bolus via the catheter and ropivacaine perineural infusion initiated postoperatively. The primary outcome was time to achieve complete sensory anesthesia in the ulnar and median nerve distributions. Secondary outcomes included procedural time, procedure-related pain and complications, and postoperative pain, opioid consumption, sleep disturbances, and motor weakness. Fifty patients were enrolled in the study; all but 2 perineural catheters were successfully placed per protocol. Twenty-one of 24 (88%) and 24 of 24 (100%) patients in the supraclavicular and infraclavicular groups, respectively, achieved complete sensory anesthesia by 30 minutes (P= .088). There was no difference in the time to achieve complete sensory anesthesia. Supraclavicular patients reported more sleep disturbances postoperatively, but there were no statistically significant differences in other outcomes. Both supraclavicular and infraclavicular perineural catheters using a through-the-catheter bolus technique provide effective brachial plexus anesthesia.

A COMPARATIVE STUDY OF TWO DIFFERENT TECHNIQUES OF BRACHIAL PLEXUS BLOCK IN CHILDREN, INFRACLAVICULAR VS AXILLARY BLOCK

Background: The potential benefits of using ultrasound guidance for regional blocks include the visualization of the surrounding structures (pleura, axillary artery and vein) and the real-time control of the needle movement. Objectives: to assure the introduction of ultrasonography to improve the ability to perform these blocks with greater ease and precision. Patients and methods: Forty pediatric patients of both sexes (ASA physical status I or II )who were scheduled for upper limb surgery at or below elbow.The ages of the patients were ranging from 5 to 15 years and their body weights from 15 to 55 kg,they were randomly allocated into two equal groups (20 patients each) by sealed envelope. These groups were: Infraclavicular group ( groupI) and Axillary group (A) in which both blocks was performed using ultrasound technique. All patients received oral midazolam 0.25 : 0.33 mg/kg as apremedication. All blocks were performed by US-guidance with a Mindray Sonoline unit (DP1100 china), a 5–9 MHz 35 mm linear probe and a short-bevelled needle with extension tube (25–22 G/35–50 mm), All patients were received a sleeping dose of ketamine 1mg/kg with oxygen mask applied then the block was performed. Maintenance of anesthesia was carried out with Isoflurane 1MAC in 50% oxygen/air until the end of the surgery an increase in heart rate or blood pressure ≥10% or an increase in respiratory rate ≥20% and this was considered failed block. Postoperative analgesia was evaluated using modified objective pain score in children from 5 to 10 years old and a numeric pain scale in older children. The following parameters were detected and recorded in each group: Block performance time, The success rate, The duration of sensory and motor blockade, Post-operative analgesia and associated side effects, Results: There were no statistically significant results as regard to intra and post-operative analgesia, duration of sensory and motor blockade, however infraclavicular block was quicker to perform compared with the axillary block (7.7±2.3 vs 8.6±3.5) ,higher success rate although non-significant for infraclavicular block compared to axillary block 95.5 vs 90.9 . there was one case of vascular puncture in the infraclavicular group and no vascular puncture in the axillary group. Conclusion: Ultrasound-guided infraclavicular BPB can reduce the performance time compared to ultrasound-guided axillary block and there was no significant difference in the success rate, duration of sensory and motor blockade and complications for both blocks.

Comparative evaluation of subclavian vein catheterisation using supraclavicular versus infraclavicular approach.

Background and Aims:Infraclavicular (IC) approach of subclavian vein (SCV) catheterisation is widely used as compared to supraclavicular (SC) approach. The aim of the study was to compare the ease of catheterisation of SCV using SC versus IC approach and also record the incidence of complications related to either approach, if any.Methods:In the study, 60 patients enrolled were randomly divided into two groups of 30 patients each. In Gp. SC right SCV catheterisation was performed using SC approach and in Gp. IC catheterisation was performed using IC approach. Access time, success rate of cannulation, number of attempts to cannulate vein, ease of guidewire and catheter insertion and length of catheter inserted and any associated complications were recorded.Results:The mean access time in group SC for SCV catheterisation was 4.30 ± 1.02 min compared to 6.07 ± 2.14 min in group IC. The overall success rate in catheterisation of the right SCV using SC approach (29 out of 30) was better as compared with group IC (27 out of 30) using IC approach. First attempt success in the SC group was 75.6% as compared with 59.25% in the IC group. All successful subclavian vein catheterisations in SC group and IC group were associated with smooth insertion of guidewire following subclavian venipuncture.Conclusion:The SC approach of SCV catheterisation is comparable to IC approach in terms of landmarks accessibility, success rate and rate of complications.

Comparison between ultrasound-guided supraclavicular and infraclavicular approaches for subclavian venous catheterization in children'a randomized trial

Ultrasound (US)-guided subclavian vein (SCV) catheterization via the supraclavicular (SC) or infraclavicular (IC) approaches can be useful in children. The purpose of this study was to compare the efficacy of these approaches. This prospective, randomized study included 98 children who were <3 years old, and who were divided into two groups: the SC group (n=49) and the IC group (n=49). All SCV catheterizations were guided by US and performed by a single experienced anaesthesiologist. Data regarding puncture time, number of attempts, successful guidewire insertion, catheter insertion time, and complications were analysed. The median puncture time was longer in the IC group than the SC group (48 vs 36 s, P=0.02). Multiple attempts (number of attempts >3) were more frequently required in the IC group than the SC group (24.5 vs 6.1%, P=0.01). The incidence of guidewire misplacement was higher in the IC group than that of the SC group [10 (20.4%) vs 0 (0%), P=0.001]. Catheterization was successfully performed in all patients. No pneumothoraces or arterial punctures occurred in either group. During SCV catheterization under US guidance in paediatric patients, the SC approach yielded a shorter puncture time and decreased the incidence of guidewire misplacement when compared with the IC approach.

Comparison of the efficacy of supraclavicular approach and infraclavicular approach in ultrasound-guided brachial plexus block

Objective To compare the efficacy of supraclavicular approach and infraclavicular approach in ultrasound-guided brachial plexus block(BPB).Methods One hundred and twenty patients,ASA Ⅰ-Ⅲ,aged 18-80 yr,scheduled for upper extremity surgeries of both gender,were randomized into two groups(n =60):supraclavicular group(group SCB)and infraclavicular group(group ICB).The anesthetic mixture consisted of ropivacaine 0.375％ and lidocaine 1％ in equal volumes with epinephrine 1∶200 000,the total dose was 0.5 ml/kg.The block performance time,duration of anesthesia and success of anesthesia(surgery was accomplished without supplementary block)were recorded.A blinded observer assessed pinprick sensory block in the seven distal nerve territories(axillary,radial,musculocutaneous,median,ulnar,medial antebrachial and medial brachial cutaneous nerves)every 5 min up to 30 min after injection.Success of nerve block,side effects and complications were recorded during and after operalion.Results Group ICB was superior in success rate of anesthesia and nerve block of ulnar,medial antebrachial and medial brachial cutaneous nerves,the rate of parasthesia was lower and the block performance time was longer compared with group SCB(P ＜ 0.05).No major complications occurred in both groups.Conclusion Under ultrasound guidance,infraclavicular BPB is superior to supraclavicular approach. Key words: Nerve block; Ultrasound, interventional; Brachial plexus