Background and Aims: The retroclavicular approach of infraclavicular block (ICB) has been newly described as a feasible alternative to the classical ICB and has been postulated to be advantageous in terms of better needle visibility, safety, and more patient comfort. This systematic review and meta-analysis aimed to assess the feasibility, efficacy, and safety outcomes in adult patients undergoing upper limb surgeries under ICB by the retroclavicular approach versus other approaches of brachial plexus block. Methods: A comprehensive literature search was performed in MEDLINE, EMBASE, and Scopus from inception to 1 November 2023 and updated in May 2025. The quality of evidence (QoE) was assessed using the Cochrane RoB 2.0 tool. The primary outcomes were the adequacy of surgical anaesthesia achieved solely by the block and block performance time (BPT). Secondary outcomes included block onset time, needle tip visibility, and incidence of complications. Results: Ten trials ( n = 806; retroclavicular = 392, others = 414) were included. The block success rate was similar between groups risk ratio (RR) 1.02; 95% confidence interval (CI) 0.98–1.07; P = 0.23; moderate QoE. No significant difference was observed in needling time mean difference (MD) −0.49; 95% CI − 1.69 to 0.70, pain during the procedure, or complications. In subgroup analysis, retroclavicular block (RCB) showed lower BPT compared with other ICB approaches. Needle visibility was significantly better with RCB (MD 1.14; 95% CI 0.80–1.49; P < 0.00001), although the QoE for these outcomes was low. Conclusion: The retroclavicular approach of ICB was not found to be superior or inferior to other BPBs in terms of needling time, BPT, success rate, or complications. However, it may show better needle visibility and a decrease in BPT compared to other approaches of ICB.
Garg et al. (2026) studied this question.