| Intertruncal versus classical approach to supraclavicular brachial plexus block on sensory-motor blockade for upper extremity surgery: a randomized controlled non-inferiority trial |
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Zhipeng Wang1, Jinyan Guo2, Hanbin Xie2, Guoliang Sun2, Jianqiang Guan2, Weifeng Yao2, Quehua Luo1 |
1Department of Anesthesiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
2Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China |
Corresponding author:
Weifeng Yao, Tel: +86-13416179794, Fax: +86-020-85253333,
Email: yaowf3@mail.sysu.edu.cn
Quehua Luo, Tel: +86-13580363975, Fax: +86-020-83827812,
Email: luoquehua@gdph.org.cn
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Received: 2 August 2024 • Revised: 14 February 2025 • Accepted: 4 March 2025
*Zhipeng Wang and Jinyan Guo contributed equally to this study as co-first authors. |
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| Abstract |
Background
As the characteristics of the intertruncal approach to the supraclavicular block (IA-SCB) are uncertain, we aimed to compare its effect on sensory-motor blockade with that of the classical approach (CA) within 30 min post-block.
Methods
In total, 122 patients undergoing elbow, forearm, wrist, or hand surgery were randomly assigned to receive CA-SCB or IA-SCB. Both groups received identical local anesthetic agents (1% lidocaine and 0.5% ropivacaine) in 25 ml total. The IA-SCB group received 15 ml between the middle and inferior trunks and 10 ml between the superior and middle trunks, while the CA-SCB group received 15 ml in the corner pocket and 10 ml in the center of the neural clusters. Sensory-motor blockade of all four terminal nerves was assessed every 5 min for 30 min. The non-inferiority threshold aimed to exclude the possibility that the IA-SCB was > 5% inferior to the CA-SCB in terms of the proportion of patients with complete sensory blockade at 20 min post-block.
Results
Complete sensory blockade at 20 min post-block was 79.3% and 72.7% with the CA-SCB and IA-SCB, respectively, exceeding the non-inferiority margin of –5% (–6.6%, 95% CI [–22.3%, 9.1%]; P-value for non-inferiority = 0.206). Additionally, the IA-SCB showed an inferior musculocutaneous nerve blockade, longer performance time, and higher incidence of hemidiaphragmatic paresis.
Conclusions
Our findings do not confirm the non-inferiority of the IA-SCB to the CA-SCB in achieving complete sensory blockade at 20 min post-block. Further research may be necessary to establish its efficacy in regional anesthesia. |
| Key Words:
Anesthesia; Brachial plexus; Hemidiaphragm; Nerve block; Randomized controlled trial; Supraclavicular block |
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