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. 2022 Apr 12;14(4):e24079.
doi: 10.7759/cureus.24079. eCollection 2022 Apr.

Comparison of Supraclavicular Regional Nerve Block Versus Infraclavicular Regional Nerve Block in Distal Radial Open Reduction and Internal Fixation: A Retrospective Case Series

Promil Kukreja  1 , Alexander M Kofskey  1 , Erin Ransom  2 , Chelsea McKenzie  1 , Joel Feinstein  1 , Jared Hudson  1 , Hari Kalagara  3
Affiliations

Comparison of Supraclavicular Regional Nerve Block Versus Infraclavicular Regional Nerve Block in Distal Radial Open Reduction and Internal Fixation: A Retrospective Case Series

Promil Kukreja et al. Cureus. .

Abstract

Background The management of pain in patients undergoing open reduction and internal fixation (ORIF) of distal radius fractures (DRFs) remains an area of debate for anesthesiologists due to a variety of block options and no definitive superior technique among these modalities. In this retrospective case series, we compare the efficacy of supraclavicular versus infraclavicular regional nerve blocks for surgical patients undergoing distal radial ORIF operations to determine if one approach was superior. Methodology This retrospective case series included patients undergoing ORIF of a DRF at a tertiary academic medical center between April 28, 2016, and August 23, 2021. In total, 54 patients undergoing ORIF of a DRF provided written consent for the nerve block(s) on the day of surgery. Of these 54 patients, 54 (100%) underwent primary procedures. Of the 54 primary ORIF patients, 28 (52%) received the supraclavicular block, while 26 (48%) received the infraclavicular nerve block. Results The infraclavicular and supraclavicular groups did not significantly differ regarding age, gender, American Society of Anesthesiologists, weight, or body mass index. The primary (intraoperative opioid use) and secondary (postoperative opioid use, postoperative nausea and vomiting in the post-anesthetic care unit, highest and average pain scores, and time to discharge) outcomes data were included in the study. The infraclavicular and supraclavicular groups did not significantly differ in any of the assessed outcomes except for time to discharge. Conclusions The supraclavicular block approach for distal radius ORIF offers an effective and non-inferior alternative to the infraclavicular block approach concerning effective analgesia and safety.

Keywords: infraclavicular block; oral morphine equivalents; orif distal radius; postoperative analgesia; supraclavicular block.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Patient positioned supine with the head turned away from the block side. The linear ultrasound probe placed over the supraclavicular region for the in-plane needle corner-pocket supraclavicular block technique.
Figure 2
Figure 2. Patient positioned supine with the head turned away from the block side. The linear ultrasound probe placed under the clavicle in the deltopectoral groove for the in-plane needle infraclavicular technique.
Figure 3
Figure 3. Ultrasound image of brachial plexus trunks at the supraclavicular level in relation to the subclavian artery, first rib, and pleura.
SA: subclavian artery
Figure 4
Figure 4. Ultrasound image of the local anesthetic deposited in the corner pocket for the supraclavicular block.
LA: local anesthetic
Figure 5
Figure 5. Ultrasound image of brachial plexus cords at the infraclavicular level and needle trajectory for the in-plane block technique.
MC: medial cord; LC: lateral cord; PC: posterior cord
Figure 6
Figure 6. Average oral morphine equivalent usage intraoperatively and postoperatively by group.
See this image and copyright information in PMC

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