Comparison of the Supraclavicular, Infraclavicular and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Surgical Anesthesia
Objective We hypothesized that ultrasound (US)-guided technique of the supra- and infraclavicular and axillary approaches of brachial plexus block (BPB) will produce a high quality of surgical anesthesia for operations below the shoulder independently of the approach and body mass index (BMI). Inte...
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| Format: | Article |
| Language: | English |
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Rambam Health Care Campus
2016-04-01
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| Series: | Rambam Maimonides Medical Journal |
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| Online Access: | http://rmmj.org.il/Pages/ArticleHTM.aspx?manuId=537 |
| _version_ | 1798044997141921792 |
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| author | Anatoli Stav Leonid Reytman Michael-Yohay Stav Isaak Portnoy Alexander Kantarovsky Offer Galili Shmuel Luboshitz Roger Sevi Ahud Sternberg |
| author_facet | Anatoli Stav Leonid Reytman Michael-Yohay Stav Isaak Portnoy Alexander Kantarovsky Offer Galili Shmuel Luboshitz Roger Sevi Ahud Sternberg |
| author_sort | Anatoli Stav |
| collection | DOAJ |
| description | Objective
We hypothesized that ultrasound (US)-guided technique of the supra- and infraclavicular and axillary approaches of brachial plexus block (BPB) will produce a high quality of surgical anesthesia for operations below the shoulder independently of the approach and body mass index (BMI). Intercostobrachial and medial brachial cutaneous nerves will be blocked separately because they are not a part of the brachial plexus.
Methods
This is a prospective randomized observer-blinded study. The three approaches of the US-guided BPB without neurostimulation were compared for quality, performance time, and correlation between performance time and BMI. Intercostobrachial and medial brachial cutaneous nerve blocks were used in all patients.
Results
A total of 101 patients were randomized into three groups: SCL (supraclavicular), ICL (infraclavicular), and AX (axillary). Seven patients were excluded due to various factors. All three groups were similar in demographic data, M:F proportion, preoperative diagnosis and type of surgery, anesthesiologists who performed the block, and surgical staff that performed the surgical intervention. The time between the end of the block performance and the start of the operation was also similar. The quality of the surgical anesthesia and discomfort during the operation were identical following comparison between groups. No direct positive correlation was observed between BMI and the block performance time. The time for the axillary block was slightly longer than the time for the supra- and infraclavicular approaches, but it had no practical clinical significance. Transient Horner syndrome was observed in three patients in the SCL group. No other adverse effects or complications were observed.
Conclusions
All three approaches can be used for US-guided BPB with similar quality of surgical anesthesia for operations of below the shoulder. A block of the intercostobrachial and medial brachial cutaneous nerves is recommended. Obesity is not a significant factor in relation to the time of US-guided BPB performance, or the quality of surgical anesthesia. (ClinicalTrials.gov number, NCT01442558.) |
| first_indexed | 2024-04-11T23:13:25Z |
| format | Article |
| id | doaj.art-946c976ea5d04e7e942d6dcd0afbb5f0 |
| institution | Directory Open Access Journal |
| issn | 2076-9172 |
| language | English |
| last_indexed | 2024-04-11T23:13:25Z |
| publishDate | 2016-04-01 |
| publisher | Rambam Health Care Campus |
| record_format | Article |
| series | Rambam Maimonides Medical Journal |
| spelling | doaj.art-946c976ea5d04e7e942d6dcd0afbb5f02022-12-22T03:57:44ZengRambam Health Care CampusRambam Maimonides Medical Journal2076-91722016-04-0172e001310.5041/RMMJ.10240Comparison of the Supraclavicular, Infraclavicular and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Surgical AnesthesiaAnatoli Stav0Leonid Reytman1Michael-Yohay Stav2Isaak Portnoy3Alexander Kantarovsky4Offer Galili5Shmuel Luboshitz6Roger Sevi7Ahud Sternberg81Postanesthesia Care Unit, Hillel Yaffe Medical Center, Hadera, Israel, and The Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, IsraelThe Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel, and Department of Anesthesiology, Hillel Yaffe Medical Center, Hadera, IsraelThe Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, IsraelThe Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel, and Vascular Surgery Unit, Hillel Yaffe Medical Center, Hadera, IsraelThe Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel, and Vascular Surgery Unit, Hillel Yaffe Medical Center, Hadera, IsraelThe Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel, and Vascular Surgery Unit, Hillel Yaffe Medical Center, Hadera, IsraelThe Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel, and Orthopedic Hand Surgery Unit, Hillel Yaffe Medical Center, Hadera, IsraelThe Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel, and Department of Orthopedics A, Hillel Yaffe Medical Center, Hadera, IsraelThe Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel, and Department of Surgery A, Hillel Yaffe Medical Center, Hadera, IsraelObjective We hypothesized that ultrasound (US)-guided technique of the supra- and infraclavicular and axillary approaches of brachial plexus block (BPB) will produce a high quality of surgical anesthesia for operations below the shoulder independently of the approach and body mass index (BMI). Intercostobrachial and medial brachial cutaneous nerves will be blocked separately because they are not a part of the brachial plexus. Methods This is a prospective randomized observer-blinded study. The three approaches of the US-guided BPB without neurostimulation were compared for quality, performance time, and correlation between performance time and BMI. Intercostobrachial and medial brachial cutaneous nerve blocks were used in all patients. Results A total of 101 patients were randomized into three groups: SCL (supraclavicular), ICL (infraclavicular), and AX (axillary). Seven patients were excluded due to various factors. All three groups were similar in demographic data, M:F proportion, preoperative diagnosis and type of surgery, anesthesiologists who performed the block, and surgical staff that performed the surgical intervention. The time between the end of the block performance and the start of the operation was also similar. The quality of the surgical anesthesia and discomfort during the operation were identical following comparison between groups. No direct positive correlation was observed between BMI and the block performance time. The time for the axillary block was slightly longer than the time for the supra- and infraclavicular approaches, but it had no practical clinical significance. Transient Horner syndrome was observed in three patients in the SCL group. No other adverse effects or complications were observed. Conclusions All three approaches can be used for US-guided BPB with similar quality of surgical anesthesia for operations of below the shoulder. A block of the intercostobrachial and medial brachial cutaneous nerves is recommended. Obesity is not a significant factor in relation to the time of US-guided BPB performance, or the quality of surgical anesthesia. (ClinicalTrials.gov number, NCT01442558.)http://rmmj.org.il/Pages/ArticleHTM.aspx?manuId=537Axillarybrachial plexus blockinfraclavicularregional anesthesiasupraclavicularsurgical anesthesiaultrasound-guided |
| spellingShingle | Anatoli Stav Leonid Reytman Michael-Yohay Stav Isaak Portnoy Alexander Kantarovsky Offer Galili Shmuel Luboshitz Roger Sevi Ahud Sternberg Comparison of the Supraclavicular, Infraclavicular and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Surgical Anesthesia Rambam Maimonides Medical Journal Axillary brachial plexus block infraclavicular regional anesthesia supraclavicular surgical anesthesia ultrasound-guided |
| title | Comparison of the Supraclavicular, Infraclavicular and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Surgical Anesthesia |
| title_full | Comparison of the Supraclavicular, Infraclavicular and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Surgical Anesthesia |
| title_fullStr | Comparison of the Supraclavicular, Infraclavicular and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Surgical Anesthesia |
| title_full_unstemmed | Comparison of the Supraclavicular, Infraclavicular and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Surgical Anesthesia |
| title_short | Comparison of the Supraclavicular, Infraclavicular and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Surgical Anesthesia |
| title_sort | comparison of the supraclavicular infraclavicular and axillary approaches for ultrasound guided brachial plexus block for surgical anesthesia |
| topic | Axillary brachial plexus block infraclavicular regional anesthesia supraclavicular surgical anesthesia ultrasound-guided |
| url | http://rmmj.org.il/Pages/ArticleHTM.aspx?manuId=537 |
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