Comparison of Efficacy between Retro-Clavicular and Coracoid Approach of Infraclavicular Brachial Plexus Block under Ultrasound Guidance for Upper Limb Surgeries: A Randomised Controlled Study

Background: Ultrasound guidance has transformed the way peripheral nerve blocks are performed; the supraclavicular block is the best location to produce anaesthesia across the entire upper limb. Numerous methods for implementing infraclavicular brachial plexus block have been reported in the literature and the three most common approaches are the coracoid approach, lateral sagittal approach and vertical approach. The retro clavicular approach to infraclavicular block presents several advantages over the coracoid approach such as better needle tip and shaft visibility, reduced performance time and anaesthesia-related time, less paraesthesia during block performance, and fewer needle passes than the coracoid approach.

Aims: The aim of the study is to compare the efficacy between the retro clavicular and coracoid approach of infraclavicular brachial plexus block under ultrasound guidance for upper limb surgeries.

Methods and Materials: This was a hospital-based randomized controlled study conducted at NKPSIMS and RC and LMC, Nagpur from 28-9-2022 to 31-8-2024 in total of 64 patients. Detailed medical history was obtained, physical examination was done, and required investigations were attended. Group R (study group): received infraclavicular block through retro clavicular approach and Group C (Control group): received infraclavicular block through coracoid approach with 10 ml of 0.5% Bupivacaine and 10 ml of 2% lignicaine plus adrenaline. Data was coded and analysed in statistical software STATA version 10.1, 2011. The difference in proportions up to qualitative parameters was assessed with Pearson chi-square test. P value less than 0.05 was considered statistically significant.

Results: In our study, group R (mean age+/-SD-40.48+/-13.81) and group C (mean age+/-SD--36.75+/-12.78) with a P value of 0.67. group R (female-25%, Male-75%) and group C (female-18.75%, male-81.25%). There was no statistically significant in ASA status, or BMI between both groups. There was statistically highly significant in block performance time [P value 0.0001], number of attempts [P value 0.01], sensory and motor onset time and complete sensory loss and motor paralysis time between groups [P value 0.001]. There was no statistically significant difference in terms of the need for supplemental analgesia and sparing of nerve [P value 0.30], and no statistically significant difference in terms of complications like vascular puncture, and Horner syndrome [P value 0.30].

Conclusion: Regional Anesthesia (RA) or the action of blocking nerve conduction temporarily, has been performed since the beginning of surgical interventions described in humans. It is concluded that in ASA status class I/ II/III non-obese adults undergoing elective upper limb surgeries, retro clavicular approach to infraclavicular brachial plexus block is a promising alternative to coracoid approach in terms of a faster block performance time, lesser number of attempts required for block, better sensory block times and comparable success rates and equal complication risk parameters. The reasons for better block parameters in the retro clavicular approach may be due to better needle visibility, perpendicular needle insertion path to the USG beam and the presence of a lesser number of neurovascular structures in the needle path diminishing the incidence of block-related complications. Thus, this block can be used effectively for upper limb anaesthesia in adults in whom limb abduction is difficult.