Randomized comparative study between two different techniques of intercostobrachial nerve block together with brachial plexus block during superficialization of arteriovenous fistula
- 185 Downloads
This study compared proximal and distal approaches of intercostobrachial nerve block (ICBNB) combined with infraclavicular brachial plexus block (ICBPB) during superficialization of arteriovenous fistula.
Seventy adult patients were randomized to receive ICBPB and 6 ml 0.25% bupivacaine at the level of the 3rd rib in the anterior axillary line between pectoralis minor and serratus anterior muscles (group P) or subcutaneously along the medial side of the upper arm (group D). The primary outcome was the achievement of complete sensory block. Secondary outcomes were onset of analgesia, volume of local anesthetic (LA) supplementation, fentanyl administration, success rate, and conversion to general anesthesia (GA).
Complete sensory block in the medial side of the upper arm was achieved in 91% of patients in group P and 51% in group D. Failure rate of ICBNB was higher in group D (49%) than group P (14%). Conversion to GA was determined by the attending anesthesiologist in 26% of patients in group D and 0% in group P. LA supplementation was required in 5 patients in group P and 11 patients in group D, and the mean volume of LA was statistically higher in group D than group P (9.5 ± 1.5, 7.5 ± 2 ml, respectively). Onset of sensory block was faster in group P than group D (8.75 ± 1.67 and 10 ± 2.14 min, respectively). No differences were observed regarding fentanyl administration.
ICBNB proximal approach provides a high success rate with less amount of rescue analgesia compared to the distal approach.
KeywordsAnesthesia, local Arteriovenous fistula Intercostobrachial nerve Nerve block
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest. Moustafa A. Moustafa: this author helped conduct the study, collect data, and write the manuscript. Alaa A. Kandeel: this author helped conduct the study and collect data, and approved the final draft of the manuscript.
- 4.Henry B, Graves MJ, Pękala JR, Sanna B, Hsieh WC, Tubbs RS, Walocha JA, Tomaszewski KA. Origin, branching, and communications of the intercostobrachial nerve: a meta-analysis with implications for mastectomy and axillary lymph node dissection in breast cancer. Cureus. 2017;9(3):e1101. https://doi.org/10.7759/cureus.1101.CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Neal J. Cutaneous blocks for the upper extremity. In: Hadzic A, editor. Textbook of regional anesthesia and acute pain management. New York: McGraw-Hill; 2010. pp. 467–75.Google Scholar
- 13.Hara K. Ultrasound guided intercostobrachial nerve block with ultrasound guided axillary brachial plexus block: a preliminary study. ESRA Acad. 2012;6:22047.Google Scholar
- 14.Magazzeni P, Jochum D, Iohom G, Mekler G, Albuisson E, Bouaziz H. Ultrasound-guided selective versus conventional block of the medial brachial cutaneous and the intercostobrachial nerves: a randomized clinical trial. Reg Anesth Pain Med. 2018. https://doi.org/10.1097/AAP.0000000000000823 (Epub ahead of print).CrossRefPubMedGoogle Scholar