Garg Heena, Makhija Purva, Jain Dhruv, Kumar Shailendra, Kashyap Lokesh
Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Indian J Anaesth. 2024 Jul;68(7):606-615. doi: 10.4103/ija.ija_1124_23. Epub 2024 Jun 7.
The infraclavicular brachial plexus block (ICB) provides analgesia and anaesthesia of the upper limb. It is given using the classical or the more recently described costoclavicular (CC) approach at the level of cords. This systematic review aimed to assess which approach is better for the ICB in terms of onset, performance, and safety.
This PROSPERO (vide registration number CRD42022361636) registered meta-analysis included randomised trials of patients undergoing upper limb surgery in ultrasound-guided ICB from MEDLINE, EMBASE, SCOPUS, and IRCTP from inception to March 2023. The quality of evidence was assessed using GradePro software. The primary outcomes were sensory and motor block onset time and the number of patients having complete block at 30 minutes. Secondary outcomes included block performance time (BPT), number of attempts, duration of the block, and any incidence of complications.
Five trials with 374 adult patients (classic = 185, CC = 189) were included. No significant difference was found in the sensory (Mean difference (MD): 1.44 minutes [95% confidence interval (CI): 3.06, 5.95]; I = 95%; very low level of evidence (LOE); = 0.53) and motor block onset times (MD: 0.83 minutes [95% CI: 0.96, 2.62]; I = 84%; very low LOE = 0.36) and BPT (MD: 5.06 seconds [95% CI: 38.50, 48.63]; I = 98%; very low LOE; = 0.82) in classic and CC approach of ICB. Trial sequential analysis revealed our sample size to be 0.65% of the required sample size to achieve 80% power, deeming our study underpowered.
Costoclavicular approach was not superior or inferior to the classical technique for infraclavicular brachial plexus block. However, the quality of evidence is low and further studies are needed to corroborate the findings.
锁骨下臂丛神经阻滞（ICB）可提供上肢镇痛和麻醉。它可通过经典方法或最近描述的在神经束水平的肋锁（CC）方法进行。本系统评价旨在评估哪种方法在起效、操作和安全性方面更适合ICB。
本PROSPERO（注册号CRD42022361636）注册的荟萃分析纳入了从MEDLINE、EMBASE、SCOPUS和IRCTP数据库建库至2023年3月期间接受超声引导下ICB的上肢手术患者的随机试验。使用GradePro软件评估证据质量。主要结局为感觉和运动阻滞起效时间以及30分钟时达到完全阻滞的患者数量。次要结局包括阻滞操作时间（BPT）、穿刺次数、阻滞持续时间以及任何并发症的发生率。
纳入了5项试验，共374例成年患者（经典组 = 185例，CC组 = 189例）。在ICB的经典方法和CC方法中，感觉阻滞起效时间（平均差（MD）：1.44分钟[95%置信区间（CI）：3.06，5.95]；I² = 95%；证据质量极低（LOE）；P = 0.53）、运动阻滞起效时间（MD：0.83分钟[95% CI：0.96，2.62]；I² = 84%；极低LOE；P = 0.36）和BPT（MD：5.06秒[95% CI：38.50，48.63]；I² = 98%；极低LOE；P = 0.82）方面未发现显著差异。试验序贯分析显示，我们的样本量仅为达到80%检验效能所需样本量的0.65%，表明我们的研究效能不足。
对于锁骨下臂丛神经阻滞，肋锁方法并不优于或劣于经典技术。然而，证据质量较低，需要进一步研究来证实这些发现。
