Download PDFPDF
Risk profiles of common brachial plexus block sites: results from the net-ra registry
  1. Christine Kubulus1,2,
  2. Maral Saadati3,
  3. Lukas M Müller-Wirtz4,
  4. William M Patterson4,
  5. Andre Gottschalk5,
  6. Rene Schmidt6 and
  7. Thomas Volk7
  8. for the net-ra investigators
  1. 1Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University, Saarbrücken, Germany
  2. 2OUTCOMES RESEARCH Consortium, Houston, Texas, USA
  3. 3Freelance Statistician, Saadati Solutions, Ladenburg, Germany
  4. 4Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
  5. 5Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Diakovere Henriettenstift and Friederikenstift, Hannover, Germany
  6. 6Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Marienhospital, Stuttgart, Germany
  7. 7Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
  1. Correspondence to Dr Christine Kubulus; christine.kubulus@uks.eu

Abstract

Introduction Regional anesthesia is frequently used for upper limb surgeries and postoperative pain control. Different approaches to brachial plexus blocks are similarly effective but may differ in the frequency and severity of iatrogenesis. We, therefore, examined large-scale registry data to explore the risks of typical complications among different brachial plexus block sites for regional anesthesia.

Methods 26,947 qualifying adult brachial plexus blocks (2007–2022) from the Network for Safety in Regional Anesthesia and Acute Pain Therapy registry were included in a retrospective cohort analysis. Interscalene, supraclavicular, infraclavicular, and axillary approaches were compared for block failure and bloody punctures using generalized estimating equations. For continuous procedures, we analyzed the influence of the approach on catheter failure, neurological disorders, and infections.

Results The axillary plexus block had the highest risk of block failure (adjusted OR, 2.3; 95% CI 1.02 to 5.1; p=0.04), catheter failure (adjusted OR, 1.4; 95% CI 1.1 to 2.0; p=0.02), and neurological dysfunction (adjusted OR, 3.0; 95% CI 1.5 to 5.9; p=0.002). There was no statistically significant difference among block sites for bloody punctures, while infraclavicular blocks had the highest odds for catheter-related infections.

Discussion The axillary approach to the brachial plexus had the highest odds for block failure and neurological dysfunction after catheter placement, as well as a significant risk for catheter failure. However, considering that the axillary approach precludes other complications such as pneumothorax, none of the four common approaches to the brachial plexus has a fundamentally superior risk profile.

  • REGIONAL ANESTHESIA
  • Brachial Plexus
  • COMPLICATIONS
  • Nerve Block
  • Pain Management

Data availability statement

Data are available upon reasonable request. Data and supplemental information are available from the authors upon reasonable request and after approval by the net-ra registry’s organizational committee.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request. Data and supplemental information are available from the authors upon reasonable request and after approval by the net-ra registry’s organizational committee.

View Full Text

Footnotes

  • X @willm_patterson

  • Contributors CK planned, designed and conducted the study. She contributed to the data analysis, drafted and revised the manuscript and submitted it. TV contributed to the planning, design and execution of the study, supervised the data analysis and revised the manuscript. CK and TV act as guarantors. MS provided statistical advice on the planning and design of the study, carried out the statistical analyses and contributed to the data analysis and preparation of the manuscript. LMM-W and WMP helped with the interpretation of the results and critically revised the manuscript for important intellectual content. AG and RS contributed to the planning of the study and critically reviewed the manuscript for important intellectual content.

  • Funding Support for the study was provided solely from institutional/hospital/departmental sources. The Network for Safety in Regional Anesthesia and Acute Pain Therapy is supported by the Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (N/A) and Berufsverband Deutscher Anästhesisten e.V. (N/A).) LMM-W reports funding from the German Research Foundation (DFG; reference number: MU4688-1-1).

  • Competing interests TV received honoraria for lectures from CSL Behring and Pajunk. CK, MS, LMM-W, WMP, AG and RS declare no competing interests.

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

  • 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.

Linked Articles