Summary

Different approaches to brachial plexus block for upper extremity analgesia may offer comparable efficacy but are associated with distinct adverse effect profiles. This study1 used data from the Network for Safety in Regional Anesthesia and Acute Pain Therapy registry, encompassing 26,947 adult cases, to evaluate the risk profiles of various brachial plexus block techniques. Neurological dysfunction, described as patient-reported paresthesia, neuropathic pain, or hypesthesia in the region covered by the block, was most frequently associated with the axillary approach, which also showed the highest odds of block and catheter failure. In contrast, infections—defined as mild, moderate, or severe signs of infection at the catheter insertion site—were most commonly linked to the infraclavicular approach. The incidence of bloody punctures did not differ significantly among the approaches. Despite these findings, no single brachial plexus block site demonstrated a superior overall safety profile, as each has distinct advantages and risks. These findings underscore the importance of tailoring the choice of brachial plexus block technique to the individual patient and procedural context.

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