Comparison of the Supraclavicular, Infraclavicular, and Axillary Approaches for Ultrasound Guided Brachial Plexus Block for Surgical Anaesthesia

Introduction: Brachial plexus blocks (BPB) have become integral in managing perioperative pain for upper limb surgeries, providing benefits such as reduced opioid use, enhanced postoperative pain control, and fewer side effects compared to general anaesthesia. With the advent of ultrasound (US) technology, BPB has gained precision, improved block success rates and reducing complications. Among the various approaches, the supraclavicular (SCL), infraclavicular (ICL), and axillary (AX) methods are widely employed. This study aimed to compare these three approaches under ultrasound guidance. Objectives: To compare the effectiveness, onset time, duration, safety, and complications associated with ultrasound - guided BPB using SCL, ICL, and AX approaches in patients undergoing upper limb surgeries. Material and Methods: This prospective, randomized, double - blinded study included 210 patients aged 18?60 years, ASA Grade I or II, scheduled for elective upper limb surgeries. Participants were randomized into three groups (SCL, ICL, AX) receiving 25 mL of 0.5% bupivacaine via ultrasound - guided BPB. Outcomes assessed included sensory and motor block onset and duration, imaging and needling parameters, block success rates, and complications. Data were analysed using SPSS v24.0 with p < 0.05 considered statistically significant. Results: Demographic variables were comparable across groups. Onset and duration of sensory and motor blocks showed no significant differences. Block performance time was significantly shorter in Group SCL (p<0.00001), with shorter preoperative preparation time (p=0.004). Imaging time was lower in Groups SCL and ICL, but needle depth was greater in Group ICL. Block - related pain was higher in Group ICL (p=0.032). Success rates were comparable across groups, with SCL showing a slightly higher appropriate block rate (92.8%). Complication rates were minimal, with no significant differences among groups. Conclusion: Ultrasound - guided SCL, ICL, and AX approaches for BPB are effective and safe, offering comparable success rates and minimal complications. Each approach has unique advantages, emphasizing the role of ultrasound in optimizing BPB outcomes.