Document Type : Original Article
Authors
1
Emergency Medicine, College of Medicine, Qatar University, Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
2
Internal Medicine, Mansoura General Hospital, Faculty of Medicine, Tanta University, Egypt.
3
Cardiology, Al Jufairi Diagnosis and Treatment, MOH, Qatar
4
Internal Medicine, Mansoura General Hospital, Egypt.
5
Department of Clinical Anesthesiology, Anaesthesia, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar.
6
Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
7
Department of Anesthesia and Intensive Care Medicine, Faculty of Medicine, Tanta University, Egypt.
Abstract
Introduction
Ultrasound-guided regional anesthesia has been the go-to choice for most upper limb surgical
procedures. Traditionally, anesthetists have preferred the supraclavicular brachial plexus block
(SCB) over the infraclavicular approach due to the lower complication rate. In the wake of
ultrasound guidance, all these procedures have become less cumbersome. Therefore, this
systematic review aimed to critically appraise the evidence on the comparative efficacy and
safety of ultrasound-guided SCB (USG-SCB) to other brachial plexus blocks and provide a
summary.
Methods We carried out a comprehensive literature search on three databases, i.e., Cochrane Central
Register for controlled trials (CENTRAL), PubMed, and Science Direct, for all the relevant
articles on the use of USG-SCB. Studies were then included in the review according to the
inclusion criteria. The Review Manager (RevMan 5.4) was then used in the statistical analysis.
Results The comprehensive search found 582 articles, among which 30 met our inclusion criteria for
this study. Our statistical synthesis found statistically insignificant block success rates (OR
1.15; 95% CI [0.63, 2.08] p= 0.65) and the procedure time (MD -0.15min; 95% CI [-1.00,
0.70] p= 0.73) between the USG-SCB and the other approaches to brachial plexus block.
While overall the incidence of adverse events such as Horner’s syndrome (OR 3.08; 95% CI
[0.76, 12.48] p= 0.12) and vascular puncture (OR 0.65; 95% CI [0.27, 1.55] p= 0.34) was
not significantly different between USG-SCB and the other approaches combined, a subgroup
analysis indicated that the incidence of adverse events was significantly higher in USG-SCB
compared to ultrasound-guided infraclavicular brachial plexus block (USG-ICB) and ultrasound
guided costoclavicular block (USG-CCB). However, the ultrasound-guided interscalene block
(USG-ISB) was associated with a significantly higher incidence of adverse events than the
USG-SCB.
Conclusions These study findings showed that the USG-SCB has not significantly different efficacy to
the other ultrasound-guided brachial plexus blocks. However, it is associated with a higher
incidence of adverse events than the other blocks, apart from the USG-ISB. Therefore, the
choice of this method of regional anesthesia should be made by considering its advantages and
disadvantages.
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