Ashford and St Peter's Hospital NHS Trust, St Peter's Hospital, Chertsey, UK.
Eur J Orthop Surg Traumatol. 2024 Dec;34(8):4123-4131. doi: 10.1007/s00590-024-04086-3. Epub 2024 Sep 17.
Clavicular brachial plexus blocks are a popular method to provide analgesia in upper limb surgery. Two common approaches include the infraclavicular (IC) and supraclavicular (SC) blocks. These two techniques have been compared previously; however, it is still being determined from the current literature whether one should be favoured.
A search was performed on the following databases: Ovid Medline, EMBASE and the Web of Science from inception until 30.04.2023. All RCTs comparing SC and IC approaches in upper limb orthopaedic surgery were included. The primary outcome was block success rate.
Eighteen RCTs comprising 1389 patients were included. The success rate of IC blocks was higher than SC blocks, odds ratio 0.61 (95% CI 0.41-0.91, p = 0.01). A small number of studies reported on secondary outcomes. A reduced rate of Horner's syndrome was observed in the IC group. Otherwise, no difference was noted between the approaches in terms of procedure time, sensory onset time, patient satisfaction, pain and vascular puncture.
IC blocks demonstrate a higher success rate over SC blocks. Across all studies a large variance in outcome reporting and definitions was observed. Future studies should conform to an agreed definition set to facilitate comparison.
锁骨臂丛阻滞是上肢手术中提供镇痛的常用方法。两种常见的方法包括锁骨下（IC）和锁骨上（SC）阻滞。这两种技术以前已经进行过比较；然而，目前的文献仍在确定是否应该优先考虑其中一种方法。
在以下数据库中进行了搜索：Ovid Medline、EMBASE 和 Web of Science，从开始到 2023 年 4 月 30 日。纳入了所有比较上肢骨科手术中 SC 和 IC 方法的 RCT。主要结局是阻滞成功率。
纳入了 18 项 RCT，共 1389 名患者。IC 阻滞的成功率高于 SC 阻滞，优势比 0.61（95%CI 0.41-0.91，p=0.01）。少数研究报告了次要结局。IC 组观察到霍纳氏综合征的发生率降低。否则，两种方法在手术时间、感觉起始时间、患者满意度、疼痛和血管穿刺方面没有差异。
IC 阻滞的成功率高于 SC 阻滞。在所有研究中，观察到结果报告和定义的很大差异。未来的研究应符合商定的定义集，以方便比较。
