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Retroclavicular vs supraclavicular brachial plexus block for distal upper limb surgery: a randomised, controlled, single-blinded trial.
Grape, Sina; Pawa, Amit; Weber, Eric; Albrecht, Eric.
Afiliação
  • Grape S; Department of Anaesthesia, Valais Hospital, Sion, Switzerland.
  • Pawa A; Department of Anaesthesia, Guy's & St Thomas' NHS Foundation Trust, London, UK.
  • Weber E; Department of Anaesthesia, Valais Hospital, Sion, Switzerland.
  • Albrecht E; Department of Anaesthesia, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: eric.albrecht@chuv.ch.
Br J Anaesth ; 122(4): 518-524, 2019 Apr.
Article em En | MEDLINE | ID: mdl-30857608
ABSTRACT

BACKGROUND:

Regional anaesthesia for upper limb surgery is routinely performed with brachial plexus blocks. A retroclavicular brachial plexus block has recently been described, but has not been adequately compared with another approach. This randomised controlled single-blinded trial tested the hypothesis that the retroclavicular approach, when compared with the supraclavicular approach, would increase the success rate.

METHODS:

One hundred and twenty ASA physical status 1-3 patients undergoing distal upper limb surgery were randomised to receive an ultrasound-guided retroclavicular or supraclavicular brachial plexus block with 30 mL of a 11 mixture of mepivacaine 1% and ropivacaine 0.5%, using a single-injection technique without needle tip repositioning. The primary outcome was block success rate 30 min after local anaesthetic injection, defined as a composite score of 14 of 16 points, inclusive of sensory and motor components. Secondary outcomes included needling time, time to first opioid request, oxycodone consumption, and pain scores (numeric rating scale, 0-10) at 24 h postoperatively.

RESULTS:

Success rates were 98.3% [95% confidence interval (CI) 90.8%, 99.9%] and 98.3% [95% CI 90.9%, 99.9%] in the supraclavicular and retroclavicular groups, respectively (P=0.99). The mean needling time was reduced in the supraclavicular group [supraclavicular 5.0 (95% CI 4.7, 5.4) min; retroclavicular 6.0 (95% CI 5.4, 6.6) min; P=0.006]. The mean time to first opioid request was similar between groups [supraclavicular 439 (95% CI 399, 479) min; retroclavicular 447 (95% CI 397, 498) min; P=0.19] as were oxycodone consumption [supraclavicular 10.0 (95% CI 6.5, 13.5 mg; retroclavicular 7.9 (95% CI 4.8, 11.0) mg; P=0.80] and pain scores at 24 h postoperatively [supraclavicular 1.2 (95% CI 2.1, 2.7); retroclavicular 1.5 (95% CI 1.6, 2.4); P=0.09].

CONCLUSIONS:

Ultrasound-guided retroclavicular and supraclavicular brachial plexus blocks share identical success rates, while providing similar pain relief. Reduced needling time in the supraclavicular approach is not clinically relevant. CLINICAL TRIAL REGISTRATION NCT02641613.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Extremidade Superior / Bloqueio do Plexo Braquial / Anestésicos Locais Tipo de estudo: Clinical_trials Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Extremidade Superior / Bloqueio do Plexo Braquial / Anestésicos Locais Tipo de estudo: Clinical_trials Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2019 Tipo de documento: Article