Department of Anesthesiology, Ningbo NO. 6 Hospital, Ningbo, China.
Department of Anesthesiology, Ningbo NO. 6 Hospital, Ningbo, China. Email:
Ann Palliat Med. 2021 Jan;10(1):454-461. doi: 10.21037/apm-20-2376. Epub 2021 Jan 14.
Ultrasound-guided costoclavicular (CC) brachial plexus blocks (BPBs) are a novel approach for nerve block in upper extremity surgery. However, comparisons between CC-BPB and conventional supraclavicular (SC) BPB have not clearly delineated the benefits or costs of either method.
This retrospective cohort study enrolled patients receiving BPB due to upper extremity fracture between June 2019 and May 2020. Data were collected from the medical records of patients, including age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status, side of block, and operative location. Enrolled patients were matched in a 1:2 ratio using propensity score matching models. The primary outcomes in this study were the proportions of complete sensory and motor blocks and the secondary outcomes included other block-related outcomes, pain-related outcomes, and side effects or complications.
The study enrolled 235 patients with upper extremity fracture and there was a significant difference in the side of block when comparing ultrasound-guided CC-BPB and SC-BPB. After propensity score matching, 62 patients receiving ultrasound-guided CC-BPB and 124 receiving ultrasound-guided SC-BPB were enrolled. The proportions of complete sensory and motor block at each interval after injection showed no significant difference when the groups were compared. Although CC-BPB involved a longer procedure time than SC-BPB (6.2±0.7 vs. 5.1±0.5 min, P<0.001), it provided a longer duration of nerve block (duration of sensory block: 468.2±103.5 vs. 396.5±83.4 min, P<0.001; duration of motor block: 554.6±99.5 vs. 469.7±96.0 min, P<0.001). Patients with Horner's syndrome were also more prevalent in the SC-BCB group (n=11) (8.9%) in comparison to one patient (1.6%) in CC-BPB group (P=0.04).
CC-BPB is a safe and efficient approach for upper extremity surgery.
超声引导锁骨下（CC）臂丛阻滞（BPB）是上肢手术中神经阻滞的一种新方法。然而，CC-BPB 与传统锁骨上（SC）BPB 之间的比较并未明确阐明两种方法的优势或成本。
这项回顾性队列研究纳入了 2019 年 6 月至 2020 年 5 月期间因上肢骨折接受 BPB 的患者。数据从患者的病历中收集，包括年龄、性别、体重指数（BMI）、美国麻醉医师协会（ASA）身体状况、阻滞侧和手术部位。采用倾向评分匹配模型按 1:2 的比例对纳入患者进行匹配。本研究的主要结局是完全感觉和运动阻滞的比例，次要结局包括其他阻滞相关结局、疼痛相关结局以及不良反应或并发症。
该研究纳入了 235 例上肢骨折患者，超声引导 CC-BPB 和 SC-BPB 组在阻滞侧方面存在显著差异。在进行倾向评分匹配后，纳入了 62 例接受超声引导 CC-BPB 和 124 例接受超声引导 SC-BPB 的患者。比较两组后，各时间点完全感觉和运动阻滞的比例无显著差异。虽然 CC-BPB 的操作时间长于 SC-BPB（6.2±0.7 比 5.1±0.5 分钟，P<0.001），但它提供了更长的神经阻滞持续时间（感觉阻滞持续时间：468.2±103.5 比 396.5±83.4 分钟，P<0.001；运动阻滞持续时间：554.6±99.5 比 469.7±96.0 分钟，P<0.001）。与 CC-BPB 组（1 例，1.6%）相比，SC-BCB 组中更常见霍纳综合征患者（n=11）（8.9%）（P=0.04）。
CC-BPB 是上肢手术安全有效的方法。
