Retroclavicular vs supraclavicular brachial plexus block for distal upper limb surgery: a randomised, controlled, single-blinded trial.

Détails

ID Serval
serval:BIB_DDED52A14DE7
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Retroclavicular vs supraclavicular brachial plexus block for distal upper limb surgery: a randomised, controlled, single-blinded trial.
Périodique
British journal of anaesthesia
Auteur(s)
Grape S., Pawa A., Weber E., Albrecht E.
ISSN
1471-6771 (Electronic)
ISSN-L
0007-0912
Statut éditorial
Publié
Date de publication
04/2019
Peer-reviewed
Oui
Volume
122
Numéro
4
Pages
518-524
Langue
anglais
Notes
Publication types: Journal Article ; Randomized Controlled Trial
Publication Status: 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.
Mots-clé
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
Pubmed
Web of science
Création de la notice
07/04/2019 15:53
Dernière modification de la notice
20/08/2019 17:02
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