Infraclavicular versus costoclavicular approaches to ultrasound-guided brachial plexus block: a systematic review and meta-analysis
Abordagens infraclaviculares versus costoclaviculares para bloqueio do plexo braquial guiado por ultrassom: uma revisão sistemática e meta-análise
Sara Texeira Amaral, Rafael Lombardi, Natalia Drabovski, Jeff Gadsden
Abstract
Background
The costoclavicular approach to brachial plexus block may have a more favorable anatomy than the classic infraclavicular approach. However, there are conflicting results in the literature regarding the comparative effectiveness of these two techniques.
Methods
We systematically searched for Randomized Controlled Trials (RCTs) comparing costoclavicular with infraclavicular brachial plexus blocks for upper extremity surgeries on MEDLINE, EMBASE, and Ovid. The outcomes of interest were sensory and motor block onset times, performance times, block failure, and complication rate. We performed statistical analyses using RevMan 5.4 and assessed heterogeneity using the Cochran Q test and I2 statistics. We appraised the risk of bias according to Cochrane's Risk of Bias 2 tool.
Results
We included 5 RCTs and 374 patients, of whom 189 (50.5%) were randomized to undergo costoclavicular block. We found no statistically significant differences between the two techniques regarding sensory block onset time in minutes (Mean Difference [MD = -0.39 min]; 95% CI -2.46 to 1.68 min; p = 0.71); motor block onset time in minutes (MD = -0.34 min; 95% CI -0.90 to 0.22 min; p = 0.23); performance time in minutes (MD = -0.12 min; 95% CI -0.89 to 0.64 min; p = 0.75); incidence of block failure (RR = 1.59; 95% CI 0.63 to 3.39; p = 0.63); and incidence of complications (RR = 0.60; 95% CI 0.20 to 1.84; p = 0.37).
Conclusion
This meta-analysis suggests that the CCV block may exhibit similar sensory and motor onset times when compared to the classic ICV approach in adults undergoing distal upper extremity surgery, with comparable rates of block failure and complications.
Keywords
Resumo
Resumo
Introdução
A abordagem costoclavicular para bloqueio do plexo braquial pode ter anatomia mais favorável do que a abordagem infraclavicular clássica. No entanto, existem resultados conflitantes na literatura quanto à eficácia comparativa dessas duas técnicas.
Métodos
Procuramos sistematicamente ensaios clínicos randomizados (ECR) comparando bloqueios do plexo braquial costoclavicular com infraclavicular para cirurgias de extremidades superiores no MEDLINE, EMBASE e Ovid. Os resultados de interesse foram tempos de início do bloqueio sensorial e motor, tempos de desempenho, falha do bloqueio e taxa de complicações. Realizamos análises estatísticas usando RevMan 5.4 e avaliamos a heterogeneidade usando o teste Cochran Q e estatística I2. Avaliamos o risco de viés de acordo com a ferramenta Risk of Bias 2 da Cochrane.
Resultados
Incluímos 5 ECRs e 374 pacientes, dos quais 189 (50,5%) foram randomizados para serem submetidos ao bloqueio costoclavicular. Não encontramos diferenças estatisticamente significativas entre as duas técnicas em relação ao tempo de início do bloqueio sensorial em minutos (Diferença Média [DM = -0,39 min]; IC 95% -2,46 a 1,68 min; p = 0,71); tempo de início do bloqueio motor em minutos (DM = -0,34 min; IC 95% -0,90 a 0,22 min; p = 0,23); tempo de execução em minutos (DM = -0,12 min; IC 95% -0,89 a 0,64 min; p = 0,75); incidência de falha do bloqueio (RR = 1,59; IC 95% 0,63 a 3,39; p = 0,63); e incidência de complicações (RR = 0,60; IC 95% 0,20 a 1,84; p = 0,37).
Conclusão
Esta metanálise sugere que o bloqueio CCV pode apresentar tempos de início sensório e motor semelhantes quando comparado à abordagem ICV clássica em adultos submetidos à cirurgia distal da extremidade superior, com taxas comparáveis de falha do bloqueio e complicações.
Palavras-chave
References
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Submitted date:
04/16/2023
Accepted date:
09/14/2023
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