Intertruncal versus classical approach to supraclavicular brachial plexus block on sensory-motor blockade for upper extremity surgery: a randomized controlled non-inferiority trial
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, wr...
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Korean Society of Anesthesiologists
2025-08-01
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| author | Zhipeng Wang Jinyan Guo Hanbin Xie Guoliang Sun Jianqiang Guan Weifeng Yao Quehua Luo |
| author_facet | Zhipeng Wang Jinyan Guo Hanbin Xie Guoliang Sun Jianqiang Guan Weifeng Yao Quehua Luo |
| author_sort | Zhipeng Wang |
| collection | DOAJ |
| description | 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% to 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. |
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| institution | DOAJ |
| issn | 2005-6419 2005-7563 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Korean Society of Anesthesiologists |
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| series | Korean Journal of Anesthesiology |
| spelling | doaj-art-7e8892ea4ef24eb99fc9a5c2bf2174bf2025-08-20T02:46:29ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632025-08-0178432133010.4097/kja.245269050Intertruncal versus classical approach to supraclavicular brachial plexus block on sensory-motor blockade for upper extremity surgery: a randomized controlled non-inferiority trialZhipeng Wang0Jinyan Guo1Hanbin Xie2Guoliang Sun3Jianqiang Guan4Weifeng Yao5Quehua Luo6 Department of Anesthesiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China Department of Anesthesiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, ChinaBackground 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% to 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.http://ekja.org/upload/pdf/kja-24526.pdfanesthesiabrachial plexusdiaphragmnerve blockrandomized controlled trialultrasonographyupper extremity |
| spellingShingle | Zhipeng Wang Jinyan Guo Hanbin Xie Guoliang Sun Jianqiang Guan Weifeng Yao Quehua Luo Intertruncal versus classical approach to supraclavicular brachial plexus block on sensory-motor blockade for upper extremity surgery: a randomized controlled non-inferiority trial Korean Journal of Anesthesiology anesthesia brachial plexus diaphragm nerve block randomized controlled trial ultrasonography upper extremity |
| title | Intertruncal versus classical approach to supraclavicular brachial plexus block on sensory-motor blockade for upper extremity surgery: a randomized controlled non-inferiority trial |
| title_full | Intertruncal versus classical approach to supraclavicular brachial plexus block on sensory-motor blockade for upper extremity surgery: a randomized controlled non-inferiority trial |
| title_fullStr | Intertruncal versus classical approach to supraclavicular brachial plexus block on sensory-motor blockade for upper extremity surgery: a randomized controlled non-inferiority trial |
| title_full_unstemmed | Intertruncal versus classical approach to supraclavicular brachial plexus block on sensory-motor blockade for upper extremity surgery: a randomized controlled non-inferiority trial |
| title_short | Intertruncal versus classical approach to supraclavicular brachial plexus block on sensory-motor blockade for upper extremity surgery: a randomized controlled non-inferiority trial |
| title_sort | intertruncal versus classical approach to supraclavicular brachial plexus block on sensory motor blockade for upper extremity surgery a randomized controlled non inferiority trial |
| topic | anesthesia brachial plexus diaphragm nerve block randomized controlled trial ultrasonography upper extremity |
| url | http://ekja.org/upload/pdf/kja-24526.pdf |
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