A Comparison between Retro-Clavicular and Proximal Infraclavicular Approaches for Brachial Plexus Block for Anesthesia of the Upper Limb

Abstract

Background: This comparative study hypothesize there are differences betweenultrasound guided retroclavicular
and proximal infraclavicular approaches for brachial plexus block for surgeriesinvolving lower
part of arm, elbow, forearm and hand with the use of tourniquet.
Method: About 36 patients randomly allocated into 2 groups, first group block done through retro-clavicular
approach (RCB) and the other group done by using proximalinfraclavicular block (PIB).In RCB group
needle inserted posterior to the clavicle and directed posterior to the first part of axillary artery. In PIB
needle inserted from lateral to medial after abduction of the arm more than 90° where the cords are clustered
together.
Results: Block performance time was (6.11±2.58) and (6.05±2.61) for RCB and PIB, respectively without
significant difference (p= 0.94). The onset of sensory was (12.8±1.4) and (11±2.3) for RCB and PIB,
respectively. For motor onset (17.4 ±2.3) and (15.3±3.3) and there is significant difference between both
groups (p=0.009 and 0.04), respectively. There was no significant difference in block-related pain between
the two groups (p=0.809) VRS for RCB was (1.41±0.712) and for PIB was (1.32±0.67). Tourniquetpain
reported by the patientfor RCB was 1.24±0.56 and for PIB was 1.11±0.315, there is no significant difference
between both groups (p=0.392)
Conclusion: Ultrasound guided BPB by retro-clavicular and proximal approaches are with a comparable
quality of surgical anesthesia for operations of the lower arm, elbow, forearm and hand with the use of
tourniquet, the onset of surgical anesthesia is earlier for PIB, the RCB is preferred for patients who cannot
abduct the arm.