The Need for Supplemental Blocks in Infraclavicular Brachial Plexus Blocks

Derince Training and Research Hospital

Status: Completed

Conditions: Anesthesia, Regional

Treatments: Procedure: Medial approach infraclavicular block with triple injection; Procedure: Medial approach infraclavicular block with single injection

Study type: Observational

Funder types: Other

Identifiers

NCT04102358

U1111-1240-8832

Details and patient eligibility

About

Theoretically, all surgeries below mid-humerus can be done under infraclavicular (IC) blocks. Following the introduction of ultrasonography (USG) to clinical anesthesia, plexus, and nerve blocks under the guidance of USG have gained wide acceptance for the high rates of block success and low risk of complications (1). In this study, the main aim is to evaluate the single injection and triple injection techniques in IC blocks with a USG-guided medial approach in terms of block success and the need for supplementary blocks. The secondary goals are to compare the complication rates and sensory block durations and to discuss the possible reasons for the failure of the blocks.

Full description

Theoretically all surgeries below mid-humerus can be done under infraclavicular (IC) blocks. Following the introduction of ultrasonography (USG) to the clinical anesthesia, plexus and nerve blocks under the guidance of USG have gained wide acceptance for the high rates of block success, and low risk of complications. At the same time, it was also shown that USG-guided IC blocks can shorten procedural times and accelerate the onset of the blocks.

Several methods for IC blocks have been described. Based on the anatomical knowledge, we hypothesized that in medial approaches the need for supplementary blocks would be low with single injections as well as triple injections. In this study, the main aim is to evaluate the single injection and triple injection techniques in IC blocks with a USG-guided medial approach in terms of block success and the need for supplementary blocks. The secondary goals are to compare the complication rates and sensory block durations and to discuss the possible reasons for the failure of the blocks.

Medical records of 139 patients scheduled for elective or emergent hand, wrist, forearm, elbow, and distal arm surgery were analyzed. Patients older than 14 years with ASA physical status I-III who underwent surgery between October 2017 and March 2019 were retrospectively evaluated. Exclusion criteria included non-cooperative patients, refusal of the regional anesthesia, known neuropathy that could prevent the evaluation of the efficacy of the block, different techniques used for infraclavicular brachial plexus blocks (lateral sagittal, coracoid, ...etc.), and known allergy to local anesthetic drugs.

Enrollment: 139 patients

Sex: All

Ages: 14+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• ASA physical status I-III
• upper extremity surgery
• blocks were performed by the same anesthesiologist

Exclusion criteria

• non-cooperative patients
• refusal of the regional anesthesia
• known neuropathy
• different technique used for infraclavicular brachial plexus blocks (lateral sagittal, coracoid, ...etc.)
• known allergy to local anesthetic drugs.

Trial design

139 participants in 2 patient groups

Single injection

Description:

Patients who received an infraclavicular block with a single injection technique were included in Group-S.

Treatment:

Procedure: Medial approach infraclavicular block with single injection

Triple injection

Description:

Patients who received an infraclavicular block with a triple injection technique were included in Group-T.

Treatment:

Procedure: Medial approach infraclavicular block with triple injection