A randomised comparative evaluation of supraclavicular and infraclavicular approaches to brachial plexus block for upper limb surgeries using both ultrasound and nerve stimulator

Background and Aims: The supraclavicular and infraclavicular brachial plexus blocks have a similar distribution of anaesthesia, and both can be used effectively for surgeries of the upper limb. This study aimed to compare the supraclavicular and infraclavicular approaches of brachial plexus blocks, guided by ultrasound and neurostimulation. Methods: Sixty adult patients scheduled for elective upper limb surgery of the elbow and/or below were randomly divided into two groups: infraclavicular Group (I) and supraclavicular Group (S). All the blocks were performed with the aid of ultrasound-guided nerve stimulator confirmation. The two groups were compared with respect to block performance time, onset of sensory and motor blockade, readiness for surgery, success rate and complications. The statistical analysis was performed with Student t-test and Chi-square test. Results: The block performance time for the infraclavicular group was 9.57 ± 3.19 min, whereas for supraclavicular group, it was 11.53 ± 2.90 min with similar success rates (93.3%). Onset of sensory blockade was achieved earlier (6.43 ± 2.61 min) in Group I than Group S (8.45 ± 2.87 min, P = 0.006). The onset of motor blockade was similar in Group I (7.32 ± 2.90 min) and Group S (8.68 ± 3.50 min, P = 0.121). The patient satisfaction was similar in both the groups. One patient had a pneumothorax, three patients developed Horner syndrome and another had clinically symptomatic diaphragmatic paresis in Group S. Conclusion: The infraclavicular block is more rapidly executed compared to supraclavicular block with similar success rates and fewer complications in the presence of ultrasound and nerve stimulator and hence should be preferred.