Department of Anesthesiology and Intensive Care, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Department of Anesthesiology, Regional Anesthesia & Acute Pain, Washington University in St Louis, School of Medicine, St. Louis, USA.
BMC Anesthesiol. 2024 Jul 25;24(1):254. doi: 10.1186/s12871-024-02645-z.
It is aimed to compare the block onset times and performance features of costoclavicular techniques (medial and lateral approach) versus lateral sagittal technique.
Patients were randomized into three groups. For costoclavicular techniques, ultrasound probe was placed parallel to clavicle obtaining nerve cords, axillary artery and axillary vein visual from lateral-to-medial, respectively. The block needle was advanced from lateral (Group CLB) or medial (Group CMB) to perform costoclavicular block. For lateral sagittal technique (Group LSB), ultrasound probe was placed sagittal and perpendicular below the coracoid process to obtain sagittal artery image with the cords around. Total 20 ml of 0.5% bupivacaine and 10 ml of 2% lidocaine were deposited for all groups. Sensory and motor block onset times, block performance properties, complications, and patient/surgeon satisfactions were investigated.
Among 56 patients, the primary outcome, sensory block onset time was shorter in Group CLB than Group CMB and Group LSB (10 [5-15], 10 [10-20], and 15 [10-15] minutes, respectively, p < 0.05). Motor block onset was also fastest in Group CLB (15 [10-20] mins for CLB, 20 [15-20] mins for LSB, and 22.5 [15-25] mins for CMB, p = 0.004). Block performance properties did not differ between the groups. The only complication observed was vascular puncture with an incidence of 28% in Group CMB.
Lateral approach costoclavicular technique provides fastest block onset than the other techniques. Considering the success and safety profile, this technique stands as a good alternative in clinical practice.
This study is prospectively registered to clinicaltrials.gov on 20/02/2022 (NCT05260736).
本研究旨在比较锁骨下径路（内侧和外侧入路）与外侧矢状面技术在阻滞起效时间和阻滞效果方面的差异。
将患者随机分为三组。对于锁骨下径路技术，超声探头与锁骨平行，从外侧向内侧分别获得神经束、腋动脉和腋静脉。阻滞针从外侧（CLB 组）或内侧（CMB 组）进针进行锁骨下阻滞。对于外侧矢状面技术（LSB 组），超声探头置于喙突下方矢状面和垂直方向，获得矢状动脉图像和周围神经束。三组均注入 0.5%布比卡因 20ml 和 2%利多卡因 10ml。观察感觉和运动阻滞起效时间、阻滞效果、并发症及患者/术者满意度。
在 56 例患者中，主要结局，即感觉阻滞起效时间在 CLB 组最短，明显短于 CMB 组和 LSB 组（分别为 10[5-15]、10[10-20]和 15[10-15]分钟，p<0.05）。CLB 组的运动阻滞起效也最快（CLB 组为 15[10-20]分钟，LSB 组为 20[15-20]分钟，CMB 组为 22.5[15-25]分钟，p=0.004）。三组的阻滞效果无差异。唯一观察到的并发症是血管穿刺，发生率为 28%，发生在 CMB 组。
外侧入路锁骨下技术比其他技术具有更快的阻滞起效时间。考虑到成功率和安全性，该技术在临床实践中是一种较好的选择。
本研究于 2022 年 2 月 20 日在 clinicaltrials.gov 进行了前瞻性注册（NCT05260736）。
