Comparison of Two Ultrasound-guided Infraclavicular Block Approaches with Perfusion Index for Upper Limb Surgery

To compare block characteristics of costoclavicular and lateral sagittal infraclavicular blocks by an objective criterion such as the perfusion index (PI) for upper limb surgery.

Observational study.

Department of Anesthesiology and Reanimation, Izmir KCU, Ataturk Training and Research Hospital, Izmir, Turkiye, from March to July 2021.

ASA 1-3 patients aged >18 years, who had either elbow or hand or wrist or forearm surgery, were included in the study. The patients were evaluated in two groups as costoclavicular approach (Group CC) and lateral sagittal infraclavicular approach (Group LS). Blocks were performed with 30 ml local anaesthetic containing 0.25% bupivacaine and 1% lidocaine mixture in both groups. Sensory-motor block levels and PI scores were recorded and evaluated at 5 min intervals in the first 30 minutes.

The study included 46 patients in Group CC and 50 patients in Group LS. Sensory block scores at 1st, 5th, 10th, and 15th minutes (min) and motor block scores at 1st, 5th, 10th, 15th, 20th, and 25th min were significantly higher in Group CC. The PI score was significantly higher in Group CC at the 5th and 10th min in comparison with Group LS. The complete block was achieved at 11.41 ±6.38 min in Group CC, while it was 17.8 ±7.22 min in Group LS (p<0.05).

Sensory and motor block starts earlier with costoclavicular in comparison with a lateral sagittal approach for the infraclavicular block. The PI verified this result as an objective parameter.

Infraclavicular block, Costoclavicular approach, Lateral sagittal approach, Perfusion index, Sensory block, Motor block.