Korean J Anesthesiol.  2021 Dec;74(6):522-530. 10.4097/kja.21028.

Comparison of the ulnar nerve blockade between intertruncal and corner pocket approaches for supraclavicular block: a randomized controlled trial

• Jo Y
• Park J
• Oh C
• Chung W
• Song S
• Lee J
• Kang H
• Ko Y
• Kim YH
• Hong B

• KMID: 2522640
• DOI: http://doi.org/10.4097/kja.21028

Abstract

Background
The corner pocket (CP) approach for supraclavicular block (SCB) prevents ulnar nerve (UN) sparing due to needle proximity to the lower trunk. Improved ultrasound resolution has suggested that the intertruncal (IT) approach is a suitable alternative method. We compared efficiency of these two approaches on the UN blockade.
Methods
Sixty patients were randomized to undergo SCB using the ultrasound-guided CP or IT approach. For lower trunk blockade, 10 ml of local anesthetic agents (1 : 1 mixture of 0.75% ropivacaine and 1% lidocaine) were injected in the CP (CP approach) or between the lower and middle trunks (IT approach). Additional 15 ml was injected identically to block the middle and upper trunks in both groups. Sensory and motor blockade was evaluated after intervention.
Results
Complete sensory blockade (75.9% [22/29] vs. 43.3% [13/30], P = 0.023) and complete motor blockade (82.8% [24/29] vs. 50.0% [15/30], P = 0.017) of the UN at 15 min after SCB were significantly more frequent in the IT than in the CP group. Sensory block onset time of the UN was significantly shorter in the IT compared to the CP group (15.0 [10.0; 15.0] min vs. 20.0 [15.0; 20.0] min; P = 0.012).
Conclusions
The IT approach provided a more rapid onset of UN blockade than the CP approach. These results suggest that the IT approach is a suitable alternative to the CP approach and can provide faster surgical readiness.

Keyword

Intraneural injection; Nerve injury; Onset of ulnar never block; Selective trunk block; Subclavian artery; Surgical readiness