Ultrasound-guided Supraclavicular Vs. Retroclavicular Block of the Brachial Plexus: Comparison of Ipsilateral Diaphragmatic Function: A Randomised Clinical Trial

Overview

Journal Eur J Anaesthesiol

Specialty Anesthesiology

Date 2020 Sep 14

PMID 32925256

Citations 4

Authors

Paige L Georgiadis

Kamen V Vlassakov

Megan E Patton

Philipp B Lirk

David R Janfaza

Jose L Zeballos

Aurora N Quaye

Vijay Patel

Kristin L Schreiber

Affiliations

Soon will be listed here.

Abstract

Background: The ultrasound-guided retroclavicular block (RCB) is a recently described alternative approach to brachial plexus blockade at the level of the cords. Although more distal blockade of the brachial plexus is thought to be associated with a lower incidence of phrenic nerve block, the impact of RCB on ipsilateral diaphragmatic function has not been formally investigated.

Objective: To compare the effects of supraclavicular and retroclavicular brachial plexus block on diaphragmatic function.

Setting: A single tertiary hospital, study period from December 2017 to May 2019.

Design: Double-blinded, randomised study.

Patients: A total of 40 patients undergoing upper extremity surgery below the axilla. Exclusion criteria included significant pulmonary disease, BMI more than 40 and contra-indication to peripheral nerve block.

Interventions: Patients were randomised to supraclavicular or retroclavicular brachial plexus block with ropivacaine 0.5%.

Outcome Measures: Phrenic block was assessed by measuring changes in diaphragmatic excursion using M-mode ultrasound, and maximum inspiratory volume on incentive spirometry from baseline, at 15 and 30 min postblock, and postoperatively. Comparative assessment of block characteristics included timing and distribution of sensory and motor block onset in the upper extremity, and scanning and block performance times.

Results: The incidence of phrenic block in the supraclavicular group was higher by ultrasound imaging (70 vs. 15%) and also by pulmonary function testing (55 vs. 5%), with both diaphragmatic excursion and maximum inspiratory volume decreasing to a greater extent after supraclavicular block (SCB) compared with RCB at 15, 30 min and postoperative time points (repeated measures analysis of variance, P < 0.001). There was no difference in timing and extent of distal arm block, but suprascapular and axillary nerves were more consistently blocked after SCB than after RCB.

Conclusion: The current study confirms the hypothesis that a RCB is significantly less likely to affect ipsilateral diaphragmatic function than a SCB.

Trial Registration: Clinicaltrials.gov identifier: NCT02631122.

Citing Articles

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Just the facts: brachial plexus blocks for upper extremity injuries in the emergency department.

Mirsch D, Jelic T, Prats M, Dreyfuss A, Yates E, Kummer T CJEM. 2023; 26(4):228-231.

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Luo Q, Zheng J, Yang C, Wei W, Wang K, Xiang X Korean J Anesthesiol. 2023; 76(5):413-423.

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References

Mak P, Irwin M, Ooi C, CHOW B . Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function. Anaesthesia. 2001; 56(4):352-6. DOI: 10.1046/j.1365-2044.2001.01708-2.x. View

Hebbard P, Royse C . Ultrasound guided posterior approach to the infraclavicular brachial plexus. Anaesthesia. 2007; 62(5):539. DOI: 10.1111/j.1365-2044.2007.05066.x. View

Kang R, Chung Y, Ko J, Yang M, Choi D . Reduced Hemidiaphragmatic Paresis With a "Corner Pocket" Technique for Supraclavicular Brachial Plexus Block: Single-Center, Observer-Blinded, Randomized Controlled Trial. Reg Anesth Pain Med. 2018; 43(7):720-724. DOI: 10.1097/AAP.0000000000000795. View

Dullenkopf A, Blumenthal S, Theodorou P, Roos J, Perschak H, Borgeat A . Diaphragmatic excursion and respiratory function after the modified Raj technique of the infraclavicular plexus block. Reg Anesth Pain Med. 2004; 29(2):110-4. DOI: 10.1016/j.rapm.2003.12.001. View

Petrar S, Seltenrich M, Head S, Schwarz S . Hemidiaphragmatic paralysis following ultrasound-guided supraclavicular versus infraclavicular brachial plexus blockade: a randomized clinical trial. Reg Anesth Pain Med. 2015; 40(2):133-8. DOI: 10.1097/AAP.0000000000000215. View

Ozturk N, Kavakli A . Comparison of the coracoid and retroclavicular approaches for ultrasound-guided infraclavicular brachial plexus block. J Anesth. 2017; 31(4):572-578. DOI: 10.1007/s00540-017-2359-6. View

Song J, Kim S, Jeon D, Kwon M, Yoo J . Dyspnea after supraclavicular brachial plexus block in a morbidly obese patient due to phrenic nerve block: A case report. Korean J Anesthesiol. 2019; 57(4):511-514. DOI: 10.4097/kjae.2009.57.4.511. View

Charbonneau J, Frechette Y, Sansoucy Y, Echave P . The Ultrasound-Guided Retroclavicular Block: A Prospective Feasibility Study. Reg Anesth Pain Med. 2015; 40(5):605-9. DOI: 10.1097/AAP.0000000000000284. View

Techasuk W, Gonzalez A, Bernucci F, Cupido T, Finlayson R, Tran D . A randomized comparison between double-injection and targeted intracluster-injection ultrasound-guided supraclavicular brachial plexus block. Anesth Analg. 2014; 118(6):1363-9. DOI: 10.1213/ANE.0000000000000224. View

10.

Koscielniak-Nielsen Z, Frederiksen B, Rasmussen H, Hesselbjerg L . A comparison of ultrasound-guided supraclavicular and infraclavicular blocks for upper extremity surgery. Acta Anaesthesiol Scand. 2009; 53(5):620-6. DOI: 10.1111/j.1399-6576.2009.01909.x. View

11.

Grape S, Pawa A, Weber E, Albrecht E . Retroclavicular vs supraclavicular brachial plexus block for distal upper limb surgery: a randomised, controlled, single-blinded trial. Br J Anaesth. 2019; 122(4):518-524. PMC: 6435841. DOI: 10.1016/j.bja.2018.12.022. View

12.

Ueshima H, Otake H . RETRACTED: Incidence of phrenic nerve paralysis after ultrasound-guided supraclavicular brachial plexus block. J Clin Anesth. 2019; 56:37-38. DOI: 10.1016/j.jclinane.2019.01.030. View

13.

Neal J, Gerancher J, Hebl J, Ilfeld B, McCartney C, Franco C . Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med. 2009; 34(2):134-70. PMC: 2779737. DOI: 10.1097/AAP.0b013e31819624eb. View

14.

Sinha C, Kumar N, Kumar A, Kumar A, Kumar A . Comparative evaluation of two approaches of infraclavicular brachial plexus block for upper-limb surgeries. Saudi J Anaesth. 2019; 13(1):35-39. PMC: 6329239. DOI: 10.4103/sja.SJA_737_17. View

15.

Sutton E, Bullock W, Gadsden J . The Retroclavicular Brachial Plexus Block: Additional Advantages. Reg Anesth Pain Med. 2015; 40(6):733-4. DOI: 10.1097/AAP.0000000000000318. View

16.

Rettig H, Gielen M, Boersma E, Klein J, Groen G . Vertical infraclavicular block of the brachial plexus: effects on hemidiaphragmatic movement and ventilatory function. Reg Anesth Pain Med. 2005; 30(6):529-35. DOI: 10.1016/j.rapm.2005.08.001. View

17.

Renes S, Spoormans H, Gielen M, Rettig H, van Geffen G . Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2009; 34(6):595-9. DOI: 10.1097/aap.0b013e3181bfbd83. View

18.

Beh Z, Hasan M, Lai H, Kassim N, Md Zin S, Chin K . Posterior parasagittal in-plane ultrasound-guided infraclavicular brachial plexus block-a case series. BMC Anesthesiol. 2015; 15:105. PMC: 4509774. DOI: 10.1186/s12871-015-0090-0. View

19.

Sivashanmugam T, Ray S, Ravishankar M, Jaya V, Selvam E, Karmakar M . Randomized Comparison of Extrafascial Versus Subfascial Injection of Local Anesthetic During Ultrasound-Guided Supraclavicular Brachial Plexus Block. Reg Anesth Pain Med. 2015; 40(4):337-43. DOI: 10.1097/AAP.0000000000000264. View

20.

Gunst J, Gouin F, Poirier P, Touchais S, Meunier J, Kick O . A novel supraclavicular approach to brachial plexus block. Anesth Analg. 1997; 85(1):111-6. DOI: 10.1097/00000539-199707000-00020. View