Retroclavicular vs Infraclavicular block For Upper Limb Anesthesia: A Multi-Centric Randomized Trial

Abstract Background: The coracoid approach is a simple method to perform ultrasound-guided brachial plexus regional anesthesia (RA) but its simplicity is counterbalanced by a difficult needle visualization. We hypothesized that the retroclavicular (RCB) approach is not longer to perform when compared to the coracoid (ICB) approach, and improves needle visualization. Methods: This randomized, controlled, non-inferiority trail conducted in two hospitals, included patients undergoing distal upper limb surgery. Patients were randomly assigned to a brachial plexus block (ICB or RCB). The primary outcome was performance time (sum of visualization and needling time), and was analyzed with a non-inferiority test of averages. Depth of sensory and motor blockade, surgical success, total anesthesia time, needle visualization, number of needle passes and complications were also evaluated. Subgroup analysis restricted to patients with higher body mass index was completed. Results: We included 109 patients between September 2016 and May 2017. Mean RCB performance time was 7.1% shorter than ICB (retro: 4.8 ± 2.0 min; infra: 5.2 ± 2.3 min, p=0.06) with a 95% CI reaching up to 5.8% longer. RCB conferred an ultrasound-needle angle closer to 0° and significantly improved needle visibility after the clavicle was cleared and before local anesthetic administration. No differences were found in the secondary outcomes. Similar results were found in the subgroup analysis. Conclusion: In patients undergoing distal upper limb surgery with an infraclavicular anesthesia, performance time with RCB approach was deemed clinically similar to ICB approach while improving needle visibility. Clinical Trial Registration: ClinicalTrials.gov (NCT02913625), registered 26 September 2016

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Retroclavicular vs Infraclavicular block for brachial plexus anesthesia: a multi-centric randomized trial

BMC Anesthesiology ◽

10.1186/s12871-019-0868-6 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Andrés Felipe Gil Blanco ◽

Pascal Laferrière-Langlois ◽

David Jessop ◽

Frédérick D’Aragon ◽

Yanick Sansoucy ◽

...

Keyword(s):

Brachial Plexus ◽

Subgroup Analysis ◽

Clinical Variable ◽

Clinical Trial Registration ◽

Simple Method ◽

Performance Time ◽

Upper Limb Surgery ◽

Needle Visibility ◽

Plexus Block ◽

Anesthesia Time

Abstract Background The coracoid approach is a simple method to perform ultrasound-guided brachial plexus regional anesthesia (RA) but its simplicity is counterbalanced by a difficult needle visualization. We hypothesized that the retroclavicular (RCB) approach is not longer to perform when compared to the coracoid (ICB) approach, and improves needle visualization. Methods This randomized, controlled, non-inferiority trial conducted in two hospitals, included patients undergoing distal upper limb surgery. Patients were randomly assigned to a brachial plexus block (ICB or RCB). The primary outcome was performance time (sum of visualization and needling time), and was analyzed with a non-inferiority test of averages. Depth of sensory and motor blockade, surgical success, total anesthesia time, needle visualization, number of needle passes and complications were also evaluated. Subgroup analysis restricted to patients with higher body mass index was completed. Results We included 109 patients between September 2016 and May 2017. Mean RCB performance time was 4.8 ± 2.0 min while ICB was 5.2 ± 2.3 min (p = 0.06) with a 95% CI reaching up to 5.8% longer. RCB conferred an ultrasound-needle angle closer to 0° and significantly improved needle visibility after the clavicle was cleared and before local anesthetic administration. No differences were found in the secondary outcomes. Similar results were found in the subgroup analysis. Conclusion RCB approach for brachial plexus anesthesia was similar to ICB approach in terms of time performance. Needle visibility, which represent an important clinical variable, was superior and angle between needle and ultrasound probe was close to 0° in the RCB group. Clinical trial registration ClinicalTrials.gov (NCT02913625), registered 26 September 2016.

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Retroclavicular vs Infraclavicular block For Brachial Plexus Anesthesia: A Multi-Centric Randomized Trial

10.21203/rs.2.10805/v2 ◽

2019 ◽

Author(s):

Andres Felipe Gil Blanco ◽

Pascal Laferriere-Langlois ◽

David Jessop ◽

Frederick D’Aragon ◽

Yanick Sansoucy ◽

...

Keyword(s):

Brachial Plexus ◽

Subgroup Analysis ◽

Clinical Variable ◽

Clinical Trial Registration ◽

Simple Method ◽

Performance Time ◽

Upper Limb Surgery ◽

Needle Visibility ◽

Plexus Block ◽

Anesthesia Time

Abstract Background: The coracoid approach is a simple method to perform ultrasound-guided brachial plexus regional anesthesia (RA) but its simplicity is counterbalanced by a difficult needle visualization. We hypothesized that the retroclavicular (RCB) approach is not longer to perform when compared to the coracoid (ICB) approach, and improves needle visualization. Methods: This randomized, controlled, non-inferiority trial conducted in two hospitals, included patients undergoing distal upper limb surgery. Patients were randomly assigned to a brachial plexus block (ICB or RCB). The primary outcome was performance time (sum of visualization and needling time), and was analyzed with a non-inferiority test of averages. Depth of sensory and motor blockade, surgical success, total anesthesia time, needle visualization, number of needle passes and complications were also evaluated. Subgroup analysis restricted to patients with higher body mass index was completed. Results: We included 109 patients between September 2016 and May 2017. Mean RCB performance time was 4.8 ± 2.0 min while ICB was 5.2 ± 2.3 min (p=0.06) with a 95% CI reaching up to 5.8% longer. RCB conferred an ultrasound-needle angle closer to 0° and significantly improved needle visibility after the clavicle was cleared and before local anesthetic administration. No differences were found in the secondary outcomes. Similar results were found in the subgroup analysis. Conclusion: RCB approach for brachial plexus anesthesia was similar to ICB approach in terms of time performance. Needle visibility, which represent an important clinical variable, was superior and angle between needle and ultrasound probe was close to 0° in the RCB group. Clinical Trial Registration: ClinicalTrials.gov (NCT02913625), registered 26 September 2016.

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Retroclavicular vs Infraclavicular block For Brachial Plexus Anesthesia: A Multi-Centric Randomized Trial

10.21203/rs.2.10805/v3 ◽

2019 ◽

Author(s):

Andres Felipe Gil Blanco ◽

Pascal Laferriere-Langlois ◽

David Jessop ◽

Frederick D’Aragon ◽

Yanick Sansoucy ◽

...

Keyword(s):

Brachial Plexus ◽

Subgroup Analysis ◽

Clinical Variable ◽

Clinical Trial Registration ◽

Simple Method ◽

Performance Time ◽

Upper Limb Surgery ◽

Needle Visibility ◽

Plexus Block ◽

Anesthesia Time

Abstract Background: The coracoid approach is a simple method to perform ultrasound-guided brachial plexus regional anesthesia (RA) but its simplicity is counterbalanced by a difficult needle visualization. We hypothesized that the retroclavicular (RCB) approach is not longer to perform when compared to the coracoid (ICB) approach, and improves needle visualization. Methods: This randomized, controlled, non-inferiority trial conducted in two hospitals, included patients undergoing distal upper limb surgery. Patients were randomly assigned to a brachial plexus block (ICB or RCB). The primary outcome was performance time (sum of visualization and needling time), and was analyzed with a non-inferiority test of averages. Depth of sensory and motor blockade, surgical success, total anesthesia time, needle visualization, number of needle passes and complications were also evaluated. Subgroup analysis restricted to patients with higher body mass index was completed. Results: We included 109 patients between September 2016 and May 2017. Mean RCB performance time was 4.8 ± 2.0 min while ICB was 5.2 ± 2.3 min (p=0.06) with a 95% CI reaching up to 5.8% longer. RCB conferred an ultrasound-needle angle closer to 0° and significantly improved needle visibility after the clavicle was cleared and before local anesthetic administration. No differences were found in the secondary outcomes. Similar results were found in the subgroup analysis. Conclusion: RCB approach for brachial plexus anesthesia was similar to ICB approach in terms of time performance. Needle visibility, which represent an important clinical variable, was superior and angle between needle and ultrasound probe was close to 0° in the RCB group. Clinical Trial Registration: ClinicalTrials.gov (NCT02913625), registered 26 September 2016.

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