J Korean Soc Surg Hand.  2014 Sep;19(3):130-135. 10.12790/jkssh.2014.19.3.130.

Comparison of Axillary and Supraclavicular Approach in Ultrasound-Guided Brachial Plexus Block

• Seo BB
• Kim YW
• Kim JM
• Lee MY
• Jang YH
• Woo SH

• KMID: 2194134
• DOI: http://doi.org/10.12790/jkssh.2014.19.3.130

Abstract

PURPOSE
We examined the success rate and adverse effects of ultrasound-guided axillary and supraclavicular approach brachial plexus block.
METHODS
From December 2013 to February 2014, 580 cases of patients received ultrasound-guided axillary approach or supraclavicular approach brachial plexus block. All blocks were performed by one anesthesiologist under ultrasound visualization using 0.2% or 0.75% ropivacaine 1% lidocaine with epinephrine in 1:200,000 as the anesthetic mixture.
RESULTS
Failure rate of ultrasound-guided brachial plexus block was 1.2% and 0.2% in axillary and supraclavicular approach, respectively. In supraclavicular approach brachial plexus block, Honer's syndrome was observed in 17.9%, chest discomfort in 14.9%, and arterial puncture in 1%. There was no adverse effect in axillary approach brachial plexus block.
CONCLUSION
Ultrasound-guided brachial plexus block serves higher success rate and lower occurrence rate of adverse effect and makes it useful for hand and upper extremity surgery. Supraclavicular approach has relatively higher success rate and lower rate of adverse effect than axillary approach.

Keyword

Brachial plexus block; Axillary approach; Supraclavicular approach; Ultrasound

MeSH Terms

Brachial Plexus*
Epinephrine
Hand
Humans
Lidocaine
Punctures
Thorax
Ultrasonography
Upper Extremity
Epinephrine
Lidocaine

Reference

1. Lim EK, Pereira R. Brachial plexus injury following brachial plexus block. Anaesthesia. 1984; 39:691–4.

2. Pearce H, Lindsay D, Leslie K. Axillary brachial plexus block in two hundred consecutive patients. Anaesth Intensive Care. 1996; 24:453–8.

3. Smith BL. Efficacy of a nerve stimulator in regional analgesia; experience in a resident training programme. Anaesthesia. 1976; 31:778–82.

4. Kapral S, Krafft P, Eibenberger K, Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg. 1994; 78:507–13.

5. Fanelli G, Casati A, Garancini P, Torri G. Nerve stimulator and multiple injection technique for upper and lower limb blockade: failure rate, patient acceptance, and neurologic complications. Study Group on Regional Anesthesia. Anesth Analg. 1999; 88:847–52.

6. Bhatia A, Lai J, Chan VW, Brull R. Case report: pneumothorax as a complication of the ultrasound-guided supraclavicular approach for brachial plexus block. Anesth Analg. 2010; 111:817–9.

7. Yuan JM, Yang XH, Fu SK, et al. Ultrasound guidance for brachial plexus block decreases the incidence of complete hemi-diaphragmatic paresis or vascular punctures and improves success rate of brachial plexus nerve block compared with peripheral nerve stimulator in adults. Chin Med J (Engl). 2012; 125:1811–6.

8. Perlas A, Lobo G, Lo N, Brull R, Chan VW, Karkhanis R. Ultrasound-guided supraclavicular block: outcome of 510 consecutive cases. Reg Anesth Pain Med. 2009; 34:171–6.

9. O'Donnell BD, Ryan H, O'Sullivan O, Iohom G. Ultrasound-guided axillary brachial plexus block with 20 milliliters local anesthetic mixture versus general anesthesia for upper limb trauma surgery: an observer-blinded, prospective, randomized, controlled trial. Anesth Analg. 2009; 109:279–83.

10. Ootaki C, Hayashi H, Amano M. Ultrasound-guided infraclavicular brachial plexus block: an alternative technique to anatomical landmark-guided approaches. Reg Anesth Pain Med. 2000; 25:600–4.

11. Thompson AM, Newman RJ, Semple JC. Brachial plexus anaesthesia for upper limb surgery: a review of eight years’ experience. J Hand Surg Br. 1988; 13:195–8.

12. O'Donnell B, Riordan J, Ahmad I, Iohom G. Brief reports: a clinical evaluation of block characteristics using one milliliter 2% lidocaine in ultrasound-guided axillary brachial plexus block. Anesth Analg. 2010; 111:808–10.

13. Marhofer P, Eichenberger U, Stockli S, et al. Ultrasonographic guided axillary plexus blocks with low volumes of local anaesthetics: a crossover volunteer study. Anaesthesia. 2010; 65:266–71.

14. Song JG, Jeon DG, Kang BJ, Park KK. Minimum effective volume of mepivacaine for ultrasound-guided supraclavicular block. Korean J Anesthesiol. 2013; 65:37–41.

15. Tran de QH, Dugani S, Correa JA, Dyachenko A, Alsenosy N, Finlayson RJ. Minimum effective volume of lidocaine for ultrasound-guided supraclavicular block. Reg Anesth Pain Med. 2011; 36:466–9.

16. Bernucci F, Gonzalez AP, Finlayson RJ, Tran de QH. A prospective, randomized comparison between perivas-cular and perineural ultrasound-guided axillary brachial plexus block. Reg Anesth Pain Med. 2012; 37:473–7.

17. Jeon DG, Kim SK, Kang BJ, Kwon MA, Song JG, Jeon SM. Comparison of ultrasound-guided supraclavicular block according to the various volumes of local anesthetic. Korean J Anesthesiol. 2013; 64:494–9.

18. Lo N, Brull R, Perlas A, et al. Evolution of ultrasound guided axillary brachial plexus blockade: retrospective analysis of 662 blocks. Can J Anaesth. 2008; 55:408–13.

19. Gamo K, Kuriyama K, Higuchi H, et al. Ultrasound-guided supraclavicular brachial plexus block in upper limb surgery: outcomes and patient satisfaction. Bone Joint J. 2014; 96-B:795–9.

20. Tran de QH, Russo G, Munoz L, Zaouter C, Finlayson RJ. A prospective, randomized comparison between ultrasound-guided supraclavicular, infraclavicular, and axillary brachial plexus blocks. Reg Anesth Pain Med. 2009; 34:366–71.

21. Knoblanche GE. The incidence and aetiology of phrenic nerve blockade associated with supraclavicular brachial plexus block. Anaesth Intensive Care. 1979; 7:346–9.

22. Gauss A, Tugtekin I, Georgieff M, Dinse-Lambracht A, Keipke D, Gorsewski G. Incidence of clinically symptomatic pneumothorax in ultrasound-guided infraclavicular and supraclavicular brachial plexus block. Anaesthesia. 2014; 69:327–36.