Comparison between Supraclavicular and Infraclavicular Brachial Plexus Block in Patients Undergoing Forearm Surgeries

BACKGROUND Of the various modalities of achieving surgical anaesthesia of the forearm, brachial plexus block by injecting local anaesthetic is considered highly beneficial and practical. Supraclavicular and infra-clavicular approaches of brachial plexus blocks provide comprehensive anaesthesia for surgeries of the forearm. The primary outcome measured was the comparison of two blocks with respect to sparing of any dermatome, whereas the secondary outcomes measured were block performance time, duration of analgesia, and complications associated with each technique. METHODS Sixty adult patients of either sex belonging to the American Society of Anesthesiologists (ASA) physical status I and II in the age range of 20-70 years scheduled to undergo surgeries of the forearm were divided into two groups: Supraclavicular (SCB group) and Infraclavicular (ICB group) of 30 each. Both the blocks were given by 30 mL of 0.375% injection Bupivacaine using a 22G, 5 cm insulated needle and nerve locator. Both the groups were compared with respect to sparing of dermatomes, block performance time, duration of analgesia and complications like Horner's syndrome, vascular puncture, and pneumothorax. Statistical analysis was performed with Student unpaired t-test and Chi-square test and p < 0.05 was considered to be statistically significant. RESULTS Block performance time was similar in both the groups. Duration of analgesia was comparable among the two groups. The incidence of incomplete radial block was significantly higher in ICB group as compared to SCB group (p=0.046, S). Incidence of Horner's syndrome in SCB group were higher than in ICB group, but they were statistically insignificant. (p=0.15, NS). One patient in SCB group had subclavian vein puncture as compared to none in ICB group and was statistically insignificant. CONCLUSIONS Supraclavicular approach for brachial plexus block provides reliable and comprehensive anaesthesia for forearm surgeries without any significant dermatomal sparing unlike infraclavicular approach. Both groups had similar block performance time and duration of analgesia for forearm surgeries. Even though SCB was associated with complications like Horner's syndrome and vascular puncture, it was transient and statistically insignificant. Hence supraclavicular approach is considered to be superior to infraclavicular approach.