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July 1, 2015Anaesthesia and Intensive CareOpen Access

Comparison of Ultrasound-Guided Supraclavicular, Infraclavicular and Below-C6 Interscalene Brachial Plexus Block for Upper Limb Surgery: A Randomised, Observer-Blinded Study

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Key result

Interscalene block below C6 prolongs onset vs supraclavicular and infraclavicular approaches, risking phrenic nerve palsy.

  • n=60

Why the study?

Does interscalene block below the C6 nerve root improve surgical effectiveness or ease of performance compared to supraclavicular and infraclavicular approaches in adults undergoing upper limb surgery?

Population

60 adult patients (ASA grade 1 to 3) undergoing upper limb (upper arm and forearm) surgery.

Comparison

Ultrasound-guided interscalene brachial plexus… vs Ultrasound-guided supraclavicular or…

Design

RCT, Randomly allocated into three groups, Observer-blinded

Authors

NBNeerja BhartiConference BoardNBNeerja BhardawajPost Graduate Institute of Medical Education and ResearchJWJyotsna WigPost Graduate Institute of Medical Education and Research

Discussion

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Overview

Interscalene block below C6 delays onset and risks phrenic palsy; challenges its use versus supraclavicular or infraclavicular approaches.

Study Design

Type

RCT (n=60)

Blinding

Observer-blinded

Randomization

Randomly allocated

Structured PICO

Does interscalene block below the C6 nerve root improve surgical effectiveness or ease of performance compared to supraclavicular and infraclavicular approaches in adults undergoing upper limb surgery?

P
Population
60 adult patients of ASA grade 1 to 3 undergoing upper limb surgery.
I
Intervention
Ultrasound-guided interscalene brachial plexus block below the C6 nerve root with nerve stimulator confirmation, using 0.5 ml/kg of equal volumes of 0.75% ropivacaine and 2% lignocaine-adrenaline.
C
Comparator
Ultrasound-guided supraclavicular or infraclavicular brachial plexus block with nerve stimulator confirmation, using the same anesthetic mixture.
O
Outcome
Ease of performance (imaging and block performance time) and surgical effectiveness (onset time, success rate, duration of block, and duration of postoperative analgesia).

Interscalene block below the C6 nerve root has a longer onset time and higher risk of phrenic nerve palsy compared to supraclavicular and infraclavicular approaches for upper limb surgery.

Cite This Study

Bharti et al. (2015) conducted an RCT in Upper limb surgery (n=60). Interscalene block below the C6 nerve root vs. Supraclavicular and infraclavicular brachial plexus blocks was evaluated on Ease of performance and surgical effectiveness (imaging and block performance time, onset time, success rate, duration of block, and duration of postoperative analgesia). Interscalene block below C6 had a significantly longer onset time than supraclavicular and infraclavicular approaches, and caused clinically detectable phrenic nerve palsy in 2 patients.

synapsesocial.com/papers/6aa57e9fbc2c7db7488e4057https://doi.org/10.1177/0310057x1504300408
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Ultrasound in the practice of brachial plexus anesthesia2002 · 92 citations
  2. 2Ultrasound-Guided Supraclavicular Block2009 · 196 citations
  3. 3Adverse Outcomes Associated With Nerve Stimulator–Guided and Ultrasound-Guided Peripheral Nerve Blocks by Supervised Trainees2012 · 133 citations
  4. 4Randomized Study of the Effect of Local Anesthetic Volume and Concentration on the Duration of Peripheral Nerve Blockade2012 · 122 citations
  5. 5The Minimum Effective Anesthetic Volume of 0.75% Ropivacaine in Ultrasound-Guided Interscalene Brachial Plexus Block2011 · 128 citations