To Compare The Retro-Clavicular And Coracoid Approach For Ultrasound Guided Infraclavicular Brachial Plexus Block For Upper Limb Surgeries.

Abstract

Background- The axillary block offers cutaneous anaesthesia for the inner upper arm as well as surgical anaesthesia for the elbow, forearm, and hand by blocking the terminal branches. Ultrasound guidance has transformed the way peripheral nerve blocks are performed; the supraclavicular block is the best location to produce anaesthesia across the entire upper limb.

Aims- To compare the retro-clavicular and coracoid approach for ultrasound guided infraclavicular brachial plexus block for upper limb surgeries.

Methods and materials- this comparative study done in department of anaesthesiology at Shri Rawatpura sarkar institute of medical sciences and research, Nava, Raipur and Shri Balaji institute of medical sciences (SBIMS) Mowa, Raipur during the period of January 2022 to January 2024 after the approval of the Institutional Ethics   Committee in total 64 patients. Group R (study group): received infraclavicular block through retro clavicular approach and Group C (Control group): received infraclavicular block through coracoid approach with 10ml of 0.5%Bupivacaine and 10 ml of 2%lignicaine plus adrenaline. Data was coded and analysed in statistical software STATA version 10.1 ,2011. P value less than 0.05 was considered statistically significant.

Results- in our study group R (mean age+/-SD-40.48+/-13.81) and group C (mean age+/-SD--36.75+/-12.78) with P value 0.67. group R (female-25%, Male-75%) and group C (female-18.75%, male-81.25%). There was no statistically significant in ASA status, BMI between both groups. There was statistically highly significant in block performance time [P value 0.0001], number of attempts [P value 0.01], sensory and motor onset time and complete sensory loss and motor paralysis time between groups [P value 0.001]. There was no statistically significant difference in terms of need for supplemental analgesia and sparing of nerve [P value 0.30], no statistically significant difference in terms of complications like vascular puncture, Horner syndrome [P value 0.30].

Conclusion- from this study we concluded that in ASA status class I/ II/III non-obese adults undergoing elective upper limb surgeries, retro clavicular approach to infraclavicular brachial plexus block is a promising alternative to coracoid approach in terms of a faster block performance time, lesser number of attempts required for block, better sensory block times and comparable success rates and equal complication risk parameters. The reasons for better block parameters in the retro clavicular approach may be due to better needle visibility, perpendicular needle insertion path to the USG beam and presence of lesser number of neurovascular structures in the needle path diminishing the incidence of block related complications. Thus, this block can be used effectively for upper limb anaesthesia in adults in whom limb abduction is difficult.