title: Low-Volume Brachial Plexus Block Providing Surgical Anesthesia for Distal Arm Surgery Comparing Supraclavicular, Infraclavicular, and Axillary Approach: A Randomized Observer Blind Trial.
abstract: Background. Distal arm surgery is widely performed under regional anesthesia with brachial plexus block. The preponderance of evidence for the efficacy relies upon injection of local anesthetic in excess of 30 mL. We aimed to compare three different ultrasound-guided brachial plexus block techniques restricting the total volume to 20 mL.Methods. 120 patients were prospectively randomized to ultrasound-guided brachial plexus block with 20 mL ropivacaine 0.75% at either the supraclavicular, infraclavicular, or axillary level. Multiinjection technique was performed with all three approaches. Primary outcome measure was performance time.Results. Performance time and procedural pain were similar between groups. Needle passes and injection numbers were significantly reduced in the infraclavicular group (P< 0.01). Nerve visibility was significantly reduced in the axillary group (P= 0.01). Success-rate was significantly increased in the supraclavicular versus the axillary group (P< 0.025). Total anesthesia-related time was significantly reduced in the supraclavicular compared to the infraclavicular group (P< 0.01). Block duration was significantly increased in the infraclavicular group (P< 0.05). No early adverse effects occurred.Conclusion. Supraclavicular and infraclavicular blocks exhibited favorable characteristics compared to the axillary block. Supraclavicular brachial plexus block with the multiinjection intracluster technique exhibited significantly reduced total anesthesia-related time and higher success rate without any early adverse events.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.
authors.forename: Mojgan
authors.initials: M
authors.lastname: Vazin
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Jensen
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.
authors.forename: Danja L
authors.initials: DL
authors.lastname: Kristensen
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital, Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.
authors.forename: Mathias
authors.initials: M
authors.lastname: Hjort
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Sygehusvej 10, 4000 Roskilde, Denmark.
authors.forename: Katrine
authors.initials: K
authors.lastname: Tanggaard
authors.affiliation: Department of Anesthesia & Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Karmakar
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Bendtsen
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Sygehusvej 10, 4000 Roskilde, Denmark.
authors.forename: Jens
authors.identifier: 0000-0002-9839-3812
authors.initials: J
authors.lastname: Børglum
mesh_terms: D000758:Anesthesia; D001132:Arm / Q000601:surgery*; D065527:Brachial Plexus Block / Q000009:adverse effects / Q000379:methods*; D002968:Clavicle / Q000601:surgery*; D003710:Demography; D006801:Humans; D008875:Middle Aged; D016037:Single-Blind Method; D014465:Ultrasonics