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. 2023 May 18:16:51-58.
doi: 10.2147/LRA.S409211. eCollection 2023.

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

Raksha Vedavyas  1 , Ravi Saravanan  1 , Gunaseelan Mirunalini  1 , Balasubramaniam Gayathri  1
Affiliations

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

Raksha Vedavyas et al. Local Reg Anesth. .

Abstract

Introduction: 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.

Patients and method: 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.

Results: 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.

Conclusion: 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.

Keywords: anesthesia; dexamethasone; infraclavicular; interventional; patient satisfaction; ropivacaine; ultrasonography.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
(A) Ultrasound image showing the infraclavicular fossa, axillary artery (AA), axillary vein (AV) and the positions of three cords for triple-point injection technique. The three brachial plexus cords are seen around the axillary artery and are marked by yellow arrows – Lateral cord (LC), Medial cord (MC), Posterior cord (PC). (B) Image showing the infraclavicular fossa with the axillary artery (AA) and the local anaesthetic (LA) as “double bubble appearance” in single-point injection technique.
Figure 2
Figure 2
Consolidated standards of reporting trials (CONSORT) flow chart depicting the flow of participants through the study.
Figure 3
Figure 3
Box and whisker plot showing the numeric rating scale of the patient satisfaction scores.
See this image and copyright information in PMC

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