1
|
Blanco AFG, Laferrière-Langlois P, Jessop D, D'Aragon F, Sansoucy Y, Albert N, Tétreault P, Echave P. Retroclavicular vs Infraclavicular block for brachial plexus anesthesia: a multi-centric randomized trial. BMC Anesthesiol 2019; 19:193. [PMID: 31656165 PMCID: PMC6815364 DOI: 10.1186/s12871-019-0868-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/16/2019] [Indexed: 12/18/2022] Open
Abstract
Background The coracoid approach is a simple method to perform ultrasound-guided brachial plexus regional anesthesia (RA) but its simplicity is counterbalanced by a difficult needle visualization. We hypothesized that the retroclavicular (RCB) approach is not longer to perform when compared to the coracoid (ICB) approach, and improves needle visualization. Methods This randomized, controlled, non-inferiority trial conducted in two hospitals, included patients undergoing distal upper limb surgery. Patients were randomly assigned to a brachial plexus block (ICB or RCB). The primary outcome was performance time (sum of visualization and needling time), and was analyzed with a non-inferiority test of averages. Depth of sensory and motor blockade, surgical success, total anesthesia time, needle visualization, number of needle passes and complications were also evaluated. Subgroup analysis restricted to patients with higher body mass index was completed. Results We included 109 patients between September 2016 and May 2017. Mean RCB performance time was 4.8 ± 2.0 min while ICB was 5.2 ± 2.3 min (p = 0.06) with a 95% CI reaching up to 5.8% longer. RCB conferred an ultrasound-needle angle closer to 0° and significantly improved needle visibility after the clavicle was cleared and before local anesthetic administration. No differences were found in the secondary outcomes. Similar results were found in the subgroup analysis. Conclusion RCB approach for brachial plexus anesthesia was similar to ICB approach in terms of time performance. Needle visibility, which represent an important clinical variable, was superior and angle between needle and ultrasound probe was close to 0° in the RCB group. Clinical trial registration ClinicalTrials.gov (NCT02913625), registered 26 September 2016.
Collapse
Affiliation(s)
- Andrés Felipe Gil Blanco
- Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Sherbrooke (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Pascal Laferrière-Langlois
- Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Sherbrooke (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - David Jessop
- Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Laval (CHUL), 2705 boul Laurier, Quebec, G1V 4G2, QC, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Sherbrooke (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Yanick Sansoucy
- Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Sherbrooke (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Natalie Albert
- Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Laval (CHUL), 2705 boul Laurier, Quebec, G1V 4G2, QC, Canada
| | - Pascal Tétreault
- Department of Biomedical Engineering, Faculty of medicine and Dentistry, University of Alberta, 1098 Research Transition Facility, Edmonton, T6G 2V2, AB, Canada
| | - Pablo Echave
- Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Sherbrooke (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
| |
Collapse
|
2
|
Langlois PL, Gil-Blanco AF, Jessop D, Sansoucy Y, D'Aragon F, Albert N, Echave P. Retroclavicular approach vs infraclavicular approach for plexic bloc anesthesia of the upper limb: study protocol randomized controlled trial. Trials 2017; 18:346. [PMID: 28732521 PMCID: PMC5521069 DOI: 10.1186/s13063-017-2086-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background The coracoid approach is recognized as the simplest approach to perform brachial plexus anaesthesia, but needle visualization needs to be improved. With a different needle entry point, the retroclavicular approach confers a perpendicular angle between the ultrasound and the needle, which theoretically enhances needle visualization. This trial compares these two techniques. The leading hypothesis is that the retroclavicular approach is comparable to the infraclavicular coracoid approach in general aspects, but needle visualization is better with this novel approach. Methods We designed a multicentre, randomized, non-inferiority trial. Patients eligible for the study are older than 18 years, able to consent, will undergo urgent or elective upper limb surgery distal to the elbow and are classified with American Society of Anaesthesiologists risk score (ASA) I-III. They will be excluded if they meet contraindicated criteria to regional anaesthesia, have affected anatomy of the clavicle or are pregnant. Randomization will be done by a computer-generated randomization schedule stratified for each site and in 1:1 ratio, and concealment will be maintained with opaque, sealed envelopes in a locked office. The primary outcome, the performance time, will be analyzed using non-inferiority analysis while secondary outcomes will be analyzed with superiority analysis. Needle visualization will be ranked on a Likert scale of 1–5 that is subjective and represents a pitfall. Two separate persons will rank needle visualization to compensate this pitfall. According to previous studies, 49 patients per group are required for statistical power of 0.90 and one-sided type I error of 0.05. Discussion The conduct of this study will bring clear answers to our questions and, if our hypothesis is confirmed, will confer an anatomic alternative to difficult coracoid infraclavicular brachial blocks or could even become a standard for brachial plexus anaesthesia. Trial registration ClinicalTrials.gov, NCT02913625. Registered on 12 September 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2086-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- P L Langlois
- Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Sherbrooke (CHUS), 3001, 12e Avenue Nord, Sherbrooke, J1H5N4, QC, Canada.
| | - A F Gil-Blanco
- Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Sherbrooke (CHUS), 3001, 12e Avenue Nord, Sherbrooke, J1H5N4, QC, Canada
| | - D Jessop
- Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Laval (CHUL), Quebec, QC, Canada
| | - Y Sansoucy
- Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Sherbrooke (CHUS), 3001, 12e Avenue Nord, Sherbrooke, J1H5N4, QC, Canada
| | - F D'Aragon
- Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Sherbrooke (CHUS), 3001, 12e Avenue Nord, Sherbrooke, J1H5N4, QC, Canada
| | - N Albert
- Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Laval (CHUL), Quebec, QC, Canada
| | - P Echave
- Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Sherbrooke (CHUS), 3001, 12e Avenue Nord, Sherbrooke, J1H5N4, QC, Canada
| |
Collapse
|