[Comparison of ultrasound-guided supraclavicular and infraclavicular approaches for brachial plexus blockade].
OBJECTIVE
Ultrasound-guided supraclavicular and infraclavicular blocks are commonly used for upper extremity surgery. The primary aims of our study were to compare block success, block onset times and performance times; secondary aims were to compare the number of needle advancements, and incidence of adverse events of ultrasound-guided supraclavicular or infraclavicular blocks.


METHODS
110 patients were randomized into two groups: supraclavicular (Group S) and infraclavicular (Group I). All the patients were given a mixture of 20 ml 0.5% levobupivacaine and 10 ml 2% lidocaine as local anesthetics. The sensory score of the seven terminal nerves was assessed every 10 min for 30 min.


RESULTS
Block success (Group I: 92.7%; Group S: 83.6%) and block onset time (Group I: 12.5 ± 4.8; Group S: 11.6 ± 3.9 min) were similar between the groups. Block performance time was shorter in Group I, than Group S (194.4 ± 65; 226.3 ± 59 sec, P<0.05). The number of needle advancements were lower in Group I than Group S (p<0.05). The Group I patients had a significantly improved block of the median and ulnar nerves than Group S, and Group S patients had a better block of the medial cutaneous nerve, than Group I (p<0.05). Horner syndrome was observed in 9 patients (16.3%) and paresthesia in one patient (1.8%) in Group S.


CONCLUSIONS
Similar block features were observed with infraclavicular and supraclavicular approaches, but infraclavicular block may be preferable to supraclavicular block due to the lower incidence of transient adverse events.
Department of Anesthesiology and Reanimation, Kocaeli University Faculty of Medicine, Turkey. yavuzg@superonline.com
Yavuz
Y
Gürkan
Tülay
T
Hoşten
Murat
M
Tekin
Sertan
S
Acar
Mine
M
Solak
Kamil
K
Toker
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D001917:Brachial Plexus / Q000000981:diagnostic imaging; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006732:Horner Syndrome / Q000209:etiology; D006801:Humans; D000077554:Levobupivacaine; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010292:Paresthesia / Q000209:etiology; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D034941:Upper Extremity / Q000294:innervation / Q000601:surgery*
D000779:Anesthetics, Local; D008012:Lidocaine; D000077554:Levobupivacaine; D002045:Bupivacaine