A Randomized controlled study comparing USG guided supraclavicular vs. infraclavicular brachial plexus block for upper limb surgeries.

Abstract

The aim of the study is to compare the Ultrasound guided supraclavicular block with infraclavicular block for forearm and hand surgeries. 120 patients (n=120) were recruited in this study. They were randomly allocated into two groups. Group-S patients (n=60) received ultrasound guided supraclavicular block and Group-I –patients (n=60) received USG guided infraclavicular block. The patients were evaluated for 1) sensory block at radial, median, ulnar and musculocutaneous nerve distribution 2) Motor block at the level of elbow, wrist and hand grip 3) Complete sensory block in all four nerve territories 4) Complete motor block in all three joints 5) Effective upper limb block    6) surgical block 7) Block performance time 8) Requirement of intra operative anxiolytics and opioids and 9) adverse events like a) accidental vessel puncture b) Horner’s syndrome and c) Pneumothorax. The results were analyzed using the SPSS software version 16.The two groups were comparable in terms of age, sex, weight distribution and other demographic parameters. No difference was observed between the two groups in terms of sensory block in the areas distributed by radial, median and musculocutaneous nerves. Group-I patients had a significantly better block in the ulnar nerve distribution than the Group-S patients (p= 0.013). For motor block, no significant results were observed between the two groups at elbow and wrist level. Group-S patients showed poor motor block at hand grip level than Group-I patients (p<0.05). Complete sensory block (p=0.013) and complete motor block (p=0.018) were superior in the Group- I. Effective upper limb block was inferior in the Group-S (68.3%) compared with Group-I (88.3%). No difference was observed between the two groups for surgical block. Compared with the Group-S, the Group-I had a longer block performance time. Intra operative requirement of anxiolytics and opioids was less in Group-I. There was a higher incidence of accidental vessel puncture in Group-I than in Group-S (36.7 % vs. 11.7 %). Complications like Horner’s syndrome and Pneumothorax were not observed in both the groups. Infraclavicular approach produces better blockade than supraclavicular approach in spite of longer performance time and higher incidence of accidental vessel puncture.