Efficacy of a single injection compared with triple injections using a costoclavicular approach for infraclavicular brachial plexus block during forearm and hand surgery: A randomized controlled trial

A Randomized Controlled Trial to Compare the Efficacy of Single versus Triple Injection Technique for Ultrasound-Guided Infraclavicular Block in Upper Limb Surgeries

Introduction

The ultrasound-guided infraclavicular brachial plexus block by triple-point injection method was aimed at blocking the three individual cords in the infraclavicular region. Recently, a single-point injection method which does not require visualization of cords to produce nerve block has been introduced. This study compared the block onset time, performance time, patient's satisfaction, and complications between the ultrasound guided triple-point injection and single-point injection methods.

Patients and Method

This randomized controlled trial was conducted in a tertiary care hospital. Sixty patients were divided into two groups - Group S: 30 patients received single-point injection method of infraclavicular block. Group T: 30 patients received triple-point injection method of infraclavicular block. Drugs used were 0.5% ropivacaine with 8 mg dexamethasone.

Results

The sensory onset time was significantly longer in Group S (11.13 ±1.83 min) than Group T (6.20 ±1.19min). No statistically significant difference was found between the two groups regarding mean motor onset time. The composite sensorimotor onset time was similar between the groups. The mean time to perform the block was significantly lesser in Group S (1.35 ±0.38 min) when compared to group T (3.44 ±0.61min). The patient satisfaction score, conversion to general anesthesia and complications were not significant among the two groups.

Conclusion

We concluded that single-point injection method had a shorter performance time and similar total onset time with less procedural complications compared with triple point injection method.

Costoclavicular brachial plexus block: A review of current evidence

The brachial plexus block can be performed through several approaches. The recently described ultrasound-guided costoclavicular block at the costoclavicular space has gained popularity, presenting promising results for upper limb anaesthesia and postoperative analgesia. This block comes as an alternative to the traditional infraclavicular approach, with results suggesting improved block quality and reduced risk of complications. This article presents a narrative review of the literature and the current evidence available. A bibliographic search was conducted in the database PubMed and relevant articles published between 2015 and December 2020 to this topic were selected.