Comparison of infraclavicular block and axillary block activities performed in ultrasonography coexisting in upper extremity surgery

Year 2023, , 275 - 281, 28.07.2023

Hansa İnceöz Zehra Baykal

https://doi.org/10.38053/acmj.1300766

Abstract

Aims: Infraclavicular and axillary block performed with ultrasound guidance are effective peripheral anesthesia methods applied in upper extremity surgery. We aimed to compare these methods in terms of duration of the block and action, first analgesic requirement and side effects.
Methods: This prospective, randomized study was conducted for upper extremity surgery. 100 patients were included to perform infraclavicular block (Group 1, n=51) and axillary block (Group 2, n=49) USG guided. Patients are between 19 and 85 years old. Both groups were premedicated with 0.3 mg/kg midazolam or 0.5-1 μg/kg fentanyl. Both groups were treated with a mixture of local anesthetics in a total volume of 30 mL [7.5 mL 0.5% bupivacaine (Bustesin®, 56.25 mg), 7.5 mL 2% prilocaine (Priloc®, 225 mg) and 5 mL saline] was injected. Block placement time, motor and sensory tests, postoperative 2nd, 4th, 8th, 12th. and analgesic requirement at the 24th hour, Bromage scale, Verbal Rating scale, nausea vomiting, patient satisfaction, and block adequacy data were recorded.
Results: In this study, 60% of the participants included were male and 40% were female. The systolic, diastolic and mean arterial pressures were higher in group of axillary blockade than those with blockade of infraclavicular blocks. Radial, median, ulnar and musculocutaneous nerve pin-prick test loss and loss of touch test was more frequent in infraclavicular block patients. According to the Bromage scale, the partial block was seen more frequently in patients who had a close block and a full block infraclavicular block. In patients with the axillary blockade, sedoanalgesia and general anesthesia needs after postoperative intraoperative 20 min and postoperative sedoanalgesia was needed. According to the postoperative Bromage scale; complete and close to the thumb and more frequent in infraclavicular block patients. In Postop VRS, it was observed that the patients with the axillary block group had mild, moderate, and severe pain complaints. Patient satisfaction in the postoperative period was similar in both groups.
Conclusion: There is no significant difference between these techniques regarding surgical adequacy and subjective postoperative analgesia and dysesthesia. Complete and near-complete block rates in the infraclavicular block approach are minimally higher than in the axillary block approach.

Keywords

Upper extremity surgery, infraclavicular block, axillary block, USG

References

• Hadzic A, Arliss J, Kerimoglu B. A comparison of infraclavicular nerve block versus general anesthesia for hand and wrist daycase surgeries. Anesthesiology. 2004;101(1):127-132.
• Erdine S, Üst Ekstremite Somatik Blokları, Rejyonel Anestezi, Nobel Tıp Kitabevleri 2008;7-33;83-108.
• Morgan GE, Mikhail MS, Murray MJ. Clinic Anesthesiology; 4Edition, The Mcgraw-Hill Companies, Chapter 17: Peripheral Nerve Blocks 2005:324-358.
• Collins VJ. Regional Anesthesia. In: Collins VJ. (Ed). Principles of Anesthesiology: General and regional anesthesia. Philadephia: Lea & Febiger Co. 1993;1232-1281.
• Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesanesthesia. J Anaesth. 2005;94:7-17.
• Chapman GA, Johnson D, Bodenham AR. Visualisation of needle position using ultrasonography. Anaesthesia 2006; 61:148-158.
• Raj PP, Montgomery SJ, Nettles D, Jenkins MT. Infraclavicular brachial plexus block a new approach. Anesth Analg 1973;52(6):897-904.
• Whifer K. Coracoid block a safe and easy technique. Br J Anaesth 1981;53(8):845-8.
• Kilka HG, Geiger P, Mehrkens HH. Infraclavicular vertical brachial plexus blockade. A new method for anesthesia of the upper extremity. An anatomical and clinical study. Anaesthesist 1995;44(5):339-44.
• Klaastad Ø, Smith HJ, Smedby O, Winther-Larssen EH, Brodal P, Breivik H. A novel infraclavicular brachial plexus block: the lateral and sagittal technique, developed by magnetic resonance imaging studies. Anesth Analg 2004;98(1):252-256.
• Er S, Baskan S, Akcay M, Akcay F, Zengin M. Effects of hydrodissection on anesthesia characteristics in ultrasound guided infraclavicular brachial plexus blockade. Medicine (Baltimore). 2022;101(23): e29241. doi: 10.1097/MD.0000000000029241.
• Erdogmus NA, Baskan S, Zengin M, Demirelli G. What is the minimum effective volume of local anaesthetic applied in brachial plexus blockage with an axillary approach under ultrasonography guidance? Cureus. 2021;13(8):e16865. doi: 10.7759/cureus.16865.
• Jankovic D. Regional Nerve Blocks and Infiltration Therapy. 3rd edition. Blackwell Publishing Ltd. 2004.:82-122.
• Fleischmann E, Marhofer P, Greher M, Waltl B, Sitzwohl C, Kapral S. Brachial plexus anaesthesia in children: lateral infraclavicular vs axillary approach. Paediatr Anaesth. 2003;13(2):103-108.
• Heid FM, Jage J, Guth M, Bauwe N, Brambrink AM. Efficacy of vertical infraclavicular plexus block vs. modified axillary plexus block: a prospective, randomized, observer-blinded study. Acta Anaesthesiol Scand. 2005;49(5):677-682.
• Jandard C, Gentili ME, Girard F, Ecoffey C, Heck M, Laxenaire MC, ve ark. Infraclavicular block with lateral approach and nerve stimulation: extent of anesthesia and adverse effects. Reg Anesth Pain Med. 2002;27(1):37-42.
• Gürkan Y, Acar S, Solak M, Toker K. Comparison of nerve stimulation vs. ultrasound-guided lateral sagittal infraclavicular block. Acta Anaesthesiol Scand. 2008;52(6):851-855.
• Arcand G, Williams SR, Chouinard P, et al. Ultrasound- guided infraclavicular versus supraclavicular block. Anesth Analg. 2005;101(3): 886-890.
• Gürkan Y, Ozdamar D, Hoşten T, Solak M, Toker K. Ultrasoundguided lateral sagittal infraclavicular block forpectoral flap release. Ağrı. 2009;21(1):39-42.
• Sandhu NS, Manne JS, Medabalmi PK, Capan LM. Sonographically guided infraclavicular brachial plexus block in adults: a retrospective analysis of 1146 cases. J Ultrasound Med. 2006;25(12):1555-1561.
• Sauter AR, Dodgson MS, Stubhaug A, Halstensen AM, Klaastad Ø. Electrical nerve stimulation or ultrasound guidance for lateral sagittal infraclavicular blocks: a randomized, controlled, observer- blinded, comparative study. Anesth Analg. 2008;106(6):1910-1915.
• Brull R, Lupu M, Perlas A, Chan VW, McCartney CJ. Compared with dual nerve stimulation, ultrasound guidance shortens the time for infraclavicular block performance. Can JAnaesth. 2009;56:812-818.
• Taboada M, Rodríguez J, Amor M, et al. Is ultrasound guidance superior to conventional nerve stimulation for coracoid infraclavicular brachial plexus block? Reg Anesth Pain Med. 2009;34:357-360.
• Gürkan Y, Hoşten T, Tekin M, Acar S, Solak M, Toker K. Comparison of ultrasound-guided supraclavicular and infraclavicular approaches for brachial plexus blockade. Ağrı 2012;24(4):159-164.
• Ootaki C, Hayashi H, Amano M. Ultrasound- guided infraclavicular brachial plexus block: an alternative technique to anatomical landmark-guided approaches. Reg Anesth Pain Med. 2000;25:600- 604.
• Williams SR, Harris P. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesth Analg. 2003;97:151823.
• Chan V, Parlas A, Rawson R. Ultrasound-guided supraclavicular brachial plexus block. Anesth Analg. 2003;97(5):1518-1523.
• Song IA, Gil NS, Choi EY, Sim SE, Min SW, Ro YJ, ve ark. Axillary approach versus the infraclavicular approach in ultrasound-guided brachial plexus block: comparison of anesthetic time. Korean J Anesthesiol. 2011;61(1):12-18.
• Tran de QH, Clemente A, Tran DQ, Finlayson RJ. A Comparison Between Ultrasound-Guided InfraclavicularBlock Using the “Double Bubble” Sign and Neurostimulation-Guided Axillary Block. Anesth Analg. 2008;107(3):1075-1078.
• Mulroy MF, McDonald SB. Regional anesthesia for outpatient surgery. Anesthesiology Clin N Am. 2003;21:289-303.
• Mannion S. Regional anaesthesia for upper limb trauma: a review. J Rom Anest Terap Int. 2013;20(1):49-59.
• Lahori VU, Raina A, Gulati S, Kumar D, Gupta SD. A randomized comparative study of efficacy of axillary and infraclavicular approaches for brachial plexus block for upper limb surgery using peripheral nerve stimulator. Indian J Anaesth. 2011;55(3):253-259.
• Sandhu NS, Capan LM. Ultrasound-guided infraclavicular brachial plexus block. Br J Anaesth. 2002;89:254-259.