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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].
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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