A comparison of infraclavicular and supraclavicular approaches to the brachial plexus using neurostimulation

Abstract

Background: A prospective, double blind study was performed to compare the clinical effect of vertical infraclavicular and supraclavicular brachial plexus block using a nerve stimulator for upper limb surgery.

Methods: One hundred patients receiving upper limb surgery under infraclavicular or supraclavicular brachial plexus block were enrolled in this study. The infraclavicular brachial plexus block was performed using the vertical technique with 30 ml of 0.5% ropivacaine. The supraclavicular brachial plexus block was performed using the plumb bob technique with 30 ml of 0.5% ropivacaine. The block performance-related pain was evaluated. This study observed which nerve type was stimulated, and scored the sensory and motor block. The quality of the block was assessed intra-operatively. The duration of the sensory and motor block as well as the complications were assessed. The patient's satisfaction with the anesthetic technique was assessed after surgery.

Results: There were no significant differences in the block performance-related pain, frequency of the stimulated nerve type, evolution of sensory and motor block quality, or the success of the block. There were no significant differences in the duration of the sensory and motor block. There was a significant difference in the incidence of Horner's syndrome. Two patients had a pneumothorax in the supraclavicular approach. There were no significant differences in the patient's satisfaction.

Conclusions: Both infraclavicular and supraclavicular brachial plexus block had similar effects. The infraclavicular approach may be preferred to the supraclavicular approach when considering the complications.

Keywords: Supraclavicular brachial plexus block; Upper limb surgery; Vertical infraclavicular brachial plexus block.

Fig. 1

Evolution of the sensory block quality in the territory of the musculocutaneous, median, radial, ulnar and medial cutaneous of the forearm nerves over the 50 minute evaluation period. Group S: supraclavicular brachial plexus block, Group I: infraclavicular brachial plexus block. ^*P < 0.05 between the groups.

Fig. 2

Proportion of patients in each group with a complete sensory block in the musculocutanous, median, radial, ulnar and medial cutaneous of forearm territories over time. Group S: supraclavicular brachial plexus block, Group I: infraclavicular brachial plexus block.

Fig. 3

Evolution of the motor block quality in the territories of the musculocutaneous, median, radial, and ulnar nerves over the 50 minute evaluation period. Group S: supraclavicualr brachial plexus block, Group I: infraclavicular brachial plexus block.

Fig. 4

Proportion of patients in each group with a complete motor block in the musculocutanous, median, radial, and ulnar territories over time. Group S: supraclavicular brachial plexus block, Group I: infraclavicular brachial plexus block.