USG Guided Supraclavicular, Vertical Infraclavicular and Coracoid Infraclavicular Approach of Brachial Plexus Block: A Double-Blind Comparative Study

Background and Aims: Amidst of COVID 19 pandemic, the importance of avoiding aerosol generating procedures (AGP) and doing procedures in regional anaesthesia wherever feasible is of immense value. Brachial plexus block (BPB) is a time tested, valuable and safe alternative to general anaesthesia for upper limb day care surgeries. This randomized double-blind study was conducted to compare three USG guided approaches for BPB using 0.5% ropivacaine for upper limb surgeries. Methods: Total 90 patients of ASA grade I- III posted for below mid arm surgeries were randomly allocated into 3 groups (n=30) according to the approach of BPB into Group SC (Supraclavicular approach), Group VI (Vertical infraclavicular approach) & Group CI (Coracoid infraclavicular approach). Patient comfort, onset, duration & degree of sensory and motor blockade; duration of complete & effective analgesia; quality of block and complications related to block were recorded and analyzed. Results: Patient comfort score 1 was seen in 19 (63.33%), 20 (66.66%) & 28 (93.33%) patients of SC, VI, CI respectively. Onset & duration of sensory and motor block was comparable among three groups (p>0.05). Duration of complete and effective analgesia was 847.33±30.16 min in group SC, 855.66±36.54 min in group VI and 856.33±42.70 min in group CI, which was similar in all three groups. There was significant decrease in complication with CI compared to other groups (p<0.05) of which pneumothorax was not seen in Group CI while 2 (6.66%) and 1 (3.33%) patients were noted in Group SC and VI, respectively. could be preferred for below middle arm surgeries due to low complication rate and patient comfort.