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A Prospective, Randomized Comparison Between Single- and Double-Injection, Ultrasound-Guided Supraclavicular Brachial Plexus Block
  1. De Q.H. Tran, MD, FRCPC,
  2. Loreto Muñoz, MD,
  3. Cedrick Zaouter, MD,
  4. Gianluca Russo, MD and
  5. Roderick J. Finlayson, MD, FRCPC
  1. From the Department of Anesthesia, McGill University, Montreal General Hospital, Montreal, Quebec, Canada.
  1. Address correspondence to: De QH Tran, MD, FRCPC, Department of Anesthesia, Montreal General Hospital, 1650 Ave Cedar, D10-144, Montreal, Quebec, Canada, H3G 1A4 (e-mail: de_tran{at}


Background and Objectives: This prospective, randomized, observer-blinded study compared single- and double-injection, ultrasound-guided supraclavicular brachial plexus block for upper extremity surgery.

Methods: Ninety-two patients were randomly allocated to receive a single-injection (n = 46) or double-injection (n = 46), ultrasound-guided supraclavicular block. Performance time (defined as the sum of imaging and needling times) and the number of needle passes were recorded during the performance of the block. Subsequently, a blinded observer recorded the onset time, block-related pain scores, success rate (surgical anesthesia), and the incidence of complications. The total anesthesia-related time was defined as the sum of the performance and onset times. The main outcome variable was the onset time.

Results: The onset time was shorter with the 2-injection technique (17.5 mins [SD, 8.4 mins] vs 21.7 mins [SD, 7.2 mins]; P = 0.021); however, performance time was also longer (7.2 mins [SD, 2.7 mins] vs 6.0 mins [SD, 2.4 mins]; P = 0.037). Thus, no differences were observed in terms of total anesthesia-related time (23.4-24.3 mins). Success rates (95.7%), block-related pain scores, and complication rates were also similar between the 2 groups. As expected, the 2-injection technique required a greater number of needle passes (3.5 [SD, 1.2] vs 1.9 [SD, 1.1]; P < 0.001). In return, it provided a faster onset for sensory and motor block of the musculocutaneous nerve and a faster sensory block of the radial nerve. However, at 30 mins, no differences were observed.

Conclusion: The double-injection, ultrasound-guided supraclavicular block provides no significant advantages compared with its single-injection counterpart.

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