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Randomized comparison between ultrasound-guided proximal and distal approaches of intercostobrachial nerve block as an adjunct to supraclavicular brachial plexus block for upper arm arteriovenous access procedures
  1. Artid Samerchua,
  2. Kittitorn Supphapipat,
  3. Prangmalee Leurcharusmee,
  4. Panuwat Lapisatepun,
  5. Pornpailin Thammasupapong and
  6. Sratwadee Lorsomradee
  1. Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  1. Correspondence to Dr Prangmalee Leurcharusmee; prangmalee.l{at}cmu.ac.th

Abstract

Backgrounds Ultrasound-guided proximal and distal approaches of the intercostobrachial nerve (ICBN) blocks facilitate analgesia for upper arm and axillary surgery, though success rates vary and lack clinical comparison. This study compared their anesthetic and analgesic efficacy as an adjunct to the supraclavicular brachial plexus block for upper arm arteriovenous access surgery.

Methods 60 end-stage renal disease patients undergoing upper arm arteriovenous access were randomly assigned to receive either proximal or distal ICBN block using 10 mL of a mixture of levobupivacaine and lidocaine with epinephrine. The primary outcome was a successful ICBN block, defined as a cutaneous sensory blockade at both the medial upper arm and axilla 30 min after the block. Secondary outcomes included block performance, block-related complications, rate of surgical anesthesia, and postoperative analgesia.

Results The proximal approach had a higher percentage of sensory blockade at the axilla (96.7% vs 73.3%, p=0.03), but comparable rates at the medial upper arm (96.7% vs 96.7%, p=1.00). Consequently, the proximal approach had a higher overall success rate (96.7% vs 73.3%, difference: 23.3%; 95% CI: 6.3%, 40.4%; p=0.03). Both groups had similar surgical anesthesia rates of 93.3%. No significant differences were found in performance time, procedural pain, or postoperative pain intensity.

Conclusions Proximal ICBN block consistently reduced sensation in the medial upper arm and axilla, while one-quarter of distal blocks spared the axilla. Both approaches, in combination with a supraclavicular brachial plexus block, were effective for upper arm arteriovenous access procedures. However, the proximal approach may be preferable for axillary surgery.

Trial registration number TCTR20200730006.

  • REGIONAL ANESTHESIA
  • Nerve Block
  • Brachial Plexus

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Footnotes

  • Contributors AS, KS, and PrL participated in the conceptualization, methodology, investigation, formal analysis, writing the original draft, reviewing, and editing of the manuscript, and final manuscript approval. PaL, PT, and SL participated in the conceptualization, investigation, and approval of the final manuscript. PrL is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note We used ChatGPT 4.0 for language correction during the preparation of the manuscript.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.