İnfraklavikular brakial pleksus bloğunda kostoklavikular yaklaşımların geleneksel lateral sagittal tekniğe karşı etkinliğinin ve performans özelliklerinin karşılaştırılması: Randomize kontrollü çalışma

Abstract

Background and Aim: Blocking brachial plexus with an intracluster injection in the costoclavicular fossa has been defined recently. Here, it is aimed to compare infraclavicular techniques including lateral versus medial approach costoclavicular, and traditional lateral sagittal approach. A quicker sensory block onset time was hypothesized on behalf of lateral costoclavicular approach.Methods: After obtaining ethical approval and clinicaltrials.gov registry, blocks were performed according to randomization. For the lateral sagittal block (LSB), two separate local anaesthetic (LA) injections were made posterior and medial aspect of the subclavian artery. For costoclavicular blocks, single LA injection were administered into the triangular cluster of cords, and defined costoclavicular lateral block (CLB) or costoclavicular medial block (CMB) according to the direction of needle placement. Sensory and motor block onset times, block performance properties (ideal ultrasound visualization time, number of needle maneuvers, need for additional needle maneuver, number of injections, perceived difficulty of performance), and time to regain sensory and motor activity were investigated.Results: Demographics were presented in Table 1. Sensory onset was fastest in CLB group (n=18) comparing to LSB group (n=20), and also CMB group (n=18) (10[5-15] vs 15[10-15], and 10[10-20] minutes, respectively, p=0.01) (Figure 1A). This was also valid for motor block onset (15[10-20], 20[15-20], and 22.5[15-25] minutes, respectively, p=0.004). Block performance properties and comfort parameters did not differ between the three groups (Table 2). Both motor and sensory activity were returned in between 12th and 18th hours, and were similar in all groups (Figure 1B).Conclusion: Lateral approach to costoclavicular block exhibited faster sensory and motor block onset than medial costoclavicular and lateral sagittal approach. All techniques were similar in terms of performance properties, and demonstrated similar perioperative comfort.