Published: 2016-12-30

A comparison of two approaches to brachial plexus anaesthesia

Rajib Hazarika, Tejwant Rajkhowa, Mridu Paban Nath, Samit Parua


Background: A prospective, double blind study was performed to compare the clinical effect of vertical infraclavicular and supraclavicular brachial plexus block using a nerve stimulation technique for upper limb surgery.

Methods: Eighty patients undergoing upper limb surgery under infraclavicular or supraclavicular brachial plexus block were enrolled into this study. The infraclavicular brachial plexus block was performed using the vertical technique (group I; N=40). The supraclavicular brachial plexus block was performed using the Kulenkampf technique (group S; N=40). In both the groups 30 ml of 0.5% ropivacaine was used as the local anaesthetic. The block performance time, the duration of onset of sensory and motor block was evaluated in both the groups S & I. The quality of the block & associated complications were also assessed.

Results: A significant difference in the block performance time with comparable duration of onset of sensory was noted between the two groups S & I. Greater incidence of Horner’s syndrome was noted in group S.

Conclusions: Supraclavicular brachial plexus block may be easier to perform than infraclavicular brachial plexus block. The infraclavicular approach may be preferred to the supraclavicular approach when considering the complications.


Brachial plexus block, Supraclavicular block, Infraclavicular block

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Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi Journal of Anesthesia. 2015;9(2):148-54.

Halstead C. Great moments in the history of anaesthesiology In: A practice of anesthesia. 7th ed. London, UK: Lioyd-Luke; 2003:5.

Franco CD, Vieira ZE. 1,001 subclavian perivascular brachial plexus blocks: success with a nerve stimulator. Reg Anesth Pain Med. 2000;25:41-6.

Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJ, Franco CD et al. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med. 2009;34:134-70.

Franco C, Gloss F, Voronov G, Serge G. Tyler S, Stojiljkovic L. Supraclavicular block in the obese population: an analysis of 2020 blocks. Anesth Analg. 2006;102:1252-4.

Trehan V, Srivastava U, Kumar A, Saxena S, Shekhar C. Comparison of two approaches of infraclavicular brachial plexus block for orthopaedic surgery below mid-humerus id-humerus. Indian J Anaesth. 2010;54:210-4.

Brown AR. Anaesthesia for procedures of the hand and elbow. Best Pract Res Clin Anaesthesiol. 2002;16:227-46.

Kilka HG, Geiger P, Mehrkens HH. Infraclavicular vertical brachial plexus blockade. A new method for anesthesia of the upper extremity. An anatomical and clinical study. Anaesthesist. 1995;44:339-44.