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OP009 Extrafascial injection versus intrafascial injection for interscalene brachial plexus block: a systematic review and meta-analysis
  1. Eslam Afifi1,
  2. Mazen Negmeldin Aly Yassin2,
  3. Mohamed El-Samahy3,
  4. Yusra Arafeh4,
  5. Mahfouz Sharapi5 and
  6. Jubil Thomas6
  1. 1Benha Medical University, Banha, Egypt
  2. 2Faculty of Medicine, Helwan University, Egypt, Helwan, Egypt
  3. 3Faculty of Medicine, Zagazig University, Egypt , Zagazig , Egypt
  4. 4Jordan University of Science and Technolog, Irbid, Jordan
  5. 5Ourl Lady Of Lourdes Hospital, Drogheda, RCSI Group, Ireland , Dublin, Ireland
  6. 6Ourl Lady Of Lourdes Hospital, Drogheda, RCSI Group, Ireland, Dublin, Ireland


Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)

Background and Aims Ultrasound-guided Interscalene brachial plexus block is typically administered to patients undergoing surgery in the upper limbs. Recently, extrafascial injection has been introduced; however, its efficacy and safety remain debatable. This systematic review meta-analysis (PROSPERO: CRD42023426498) sought to compare extrafascial and intrafascial injections.

Methods We systematically searched six electronic databases for randomised clinical trials comparing extrafascial and intrafascial injections for interscalene brachial plexus block. A random-effects model calculated risk ratio or mean differences (MD) with a 95% confidence interval (CI). The Cochrane Risk of Bias tool was used to assess the risk of bias.

Results Six studies, a total of 485 patients, met our criteria. The risk of bias in four studies was low, with some concerns in two. The incidence of hemidiaphragmatic paresis was less in the extrafascial injection: [RR 3.01; 95% CI (2.13, 4.25); P < 0.00001]. There was a significantly higher incidence of complications in intrafascial compared to the extrafascial group for paraesthesia and hoarseness; RR 7.39; 95% CI (1.88, 29.07); P = 0.004] and [RR 3.88; 95% CI (0.99, 15.19); P = 0.05], respectively. Onsets of motor and sensory block were rapid in the intrafascial group: [MD -5.48; 95% CI (-8.85, -2.11); P = 0.001] and [MD -5.01; 95% CI (-8.49, -1.54); P = 0.005], respectively. The duration of sensory block was not significantly different between both groups: [MD 17.92; 95% CI (-38.15, 74.00); P = 0.53].

Abstract OP009 Figure 1

Forest plot depicting the incidence of extrafascial versus intrafascial incidence of complications

Abstract OP009 Figure 2

Forest plot describing the onset of sensory block of extrafascial versus intrafascial injection in interscalene brachial plexus block

Abstract OP009 Figure 3

Forest plot describing the duration of sensory block between the extrafascial versus intrafascial injection during interscalene brachial plexus block

Conclusions Extrafascial injection effectively reduces block-related complications such as hemidiaphragmatic paresis and is associated with preserving respiratory parameters such as forced vital Capacity.


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