Article Text
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.
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.
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.
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