title: A prospective, randomized comparison between ultrasound-guided supraclavicular, infraclavicular, and axillary brachial plexus blocks.
abstract: BACKGROUND
  This prospective, randomized, observer-blinded study compared ultrasound-guided supraclavicular (SCB), infraclavicular (ICB), and axillary (AXB) brachial plexus blocks for upper extremity surgery of the elbow, forearm, wrist, and hand.
  
  
  METHODS
  One hundred twenty patients were randomly allocated to receive an ultrasound-guided SCB (n = 40), ICB (n = 40), or AXB (n = 40). Performance time (defined as the sum of imaging and needling times) and the number of needle passes were recorded during the performance of the block. Subsequently, a blinded observer recorded the onset time, block-related pain scores, success rate (surgical anesthesia), and the incidence of complications. The main outcome variable was the total anesthesia-related time, defined as the sum of performance and onset times.
  
  
  RESULTS
  No differences were observed between the 3 groups in terms of total anesthesia-related time (23.1-25.5 mins), success rate (95%-97.5%), block-related pain scores, vascular puncture, and paresthesia. Compared with the supraclavicular and infraclavicular approaches, ultrasound-guided AXBs required a higher number of needle passes (6.1 [SD, 2.0] vs 2.0-2.6 [SD, 1.1-1.8]; both P < or = 0.001), a longer needling time (7.4 mins [SD, 2.2 mins] vs 4.9-5.5 mins [SD, 1.9-4.2 mins]; both P < or = 0.016), and a longer performance time (8.5 mins [SD, 2.3 mins] vs 6.0-6.2 mins [SD, 2.1-4.5 mins]; both P < or = 0.008). Supraclavicular blocks resulted in a higher rate of Horner syndrome (37.5% vs 0%-5%; both P < 0.001).
  
  
  CONCLUSIONS
  Adjunctive ultrasonography results in similar success rates, total anesthesia-related times, and block-related pain scores for the SCB, ICB, and AXB.
authors: Department of Anesthesia, Montreal General Hospital, 1650 Ave Cedar, D10-144 Montreal, Quebec H3G-1A4, Canada. de_tran@hotmail.com
authors: De Quang Hieu
authors: DQ
authors: Tran
authors: Gianluca
authors: G
authors: Russo
authors: Loreto
authors: L
authors: Muñoz
authors: Cedrick
authors: C
authors: Zaouter
authors: Roderick J
authors: RJ
authors: Finlayson
mesh_terms: D000328:Adult; D001132:Arm / Q000601:surgery; D001365:Axilla; D001917:Brachial Plexus / Q000000981:diagnostic imaging*; D002968:Clavicle; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010146:Pain / Q000503:physiopathology; D011446:Prospective Studies; D011677:Punctures / Q000379:methods; D016037:Single-Blind Method; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000379:methods*