Retroclavicular vs supraclavicular brachial plexus block for distal upper limb surgery: a randomised, controlled, single-blinded trial.
Adult
Aged
Anesthetics, Combined
/ administration & dosage
Anesthetics, Local
/ administration & dosage
Brachial Plexus
/ diagnostic imaging
Brachial Plexus Block
/ methods
Female
Humans
Male
Mepivacaine
/ administration & dosage
Middle Aged
Pain, Postoperative
/ prevention & control
Ropivacaine
/ administration & dosage
Single-Blind Method
Ultrasonography, Interventional
/ methods
Upper Extremity
/ surgery
brachial plexus
nerve block
postoperative analgesia
regional anaesthesia
ultrasound-guided
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
received:
12
10
2018
revised:
01
12
2018
accepted:
02
12
2018
entrez:
13
3
2019
pubmed:
13
3
2019
medline:
23
4
2019
Statut:
ppublish
Résumé
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. 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 1:1 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. 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]. 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. NCT02641613.
Sections du résumé
BACKGROUND
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
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 1:1 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
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
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
BACKGROUND
NCT02641613.
Identifiants
pubmed: 30857608
pii: S0007-0912(19)30007-8
doi: 10.1016/j.bja.2018.12.022
pmc: PMC6435841
pii:
doi:
Substances chimiques
Anesthetics, Combined
0
Anesthetics, Local
0
Ropivacaine
7IO5LYA57N
Mepivacaine
B6E06QE59J
Banques de données
ClinicalTrials.gov
['NCT02641613']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
518-524Informations de copyright
Copyright © 2019 British Journal of Anaesthesia. All rights reserved.
Références
Reg Anesth Pain Med. 2015 Nov-Dec;40(6):733-4
pubmed: 26488085
Anaesthesia. 2007 May;62(5):539
pubmed: 17448088
Anesth Analg. 2012 May;114(5):1131-3
pubmed: 22312122
J Anesth. 2017 Aug;31(4):572-578
pubmed: 28421316
Reg Anesth Pain Med. 2018 Oct;43(7):752-755
pubmed: 29923952
Reg Anesth Pain Med. 2015 Sep-Oct;40(5):605-9
pubmed: 26222346
Anaesthesia. 2016 Feb;71(2):213-27
pubmed: 26670119
Reg Anesth Pain Med. 2008 Sep-Oct;33(5):502-3; author reply 504
pubmed: 18774521
Reg Anesth Pain Med. 2015 Jan-Feb;40(1):11-5
pubmed: 25478758
PLoS Med. 2010 Mar 24;7(3):e1000251
pubmed: 20352064