Ultrasound-Guided Supraclavicular Brachial Plexus Block: A Decade of Advancements in Efficacy, Safety, and Clinical Outcomes – An Updated Systematic Review and Meta-Analysis.

Abstract

IntroductionUltrasound-guided regional anesthesia has been the go-to choice for most upper limb surgicalprocedures. Traditionally, anesthetists have preferred the supraclavicular brachial plexus block(SCB) over the infraclavicular approach due to the lower complication rate. In the wake ofultrasound guidance, all these procedures have become less cumbersome. Therefore, thissystematic review aimed to critically appraise the evidence on the comparative efficacy andsafety of ultrasound-guided SCB (USG-SCB) to other brachial plexus blocks and provide asummary.Methods We carried out a comprehensive literature search on three databases, i.e., Cochrane CentralRegister for controlled trials (CENTRAL), PubMed, and Science Direct, for all the relevantarticles on the use of USG-SCB. Studies were then included in the review according to theinclusion criteria. The Review Manager (RevMan 5.4) was then used in the statistical analysis.Results The comprehensive search found 582 articles, among which 30 met our inclusion criteria forthis study. Our statistical synthesis found statistically insignificant block success rates (OR1.15; 95% CI [0.63, 2.08] p= 0.65) and the procedure time (MD -0.15min; 95% CI [-1.00,0.70] p= 0.73) between the USG-SCB and the other approaches to brachial plexus block.While overall the incidence of adverse events such as Horner’s syndrome (OR 3.08; 95% CI[0.76, 12.48] p= 0.12) and vascular puncture (OR 0.65; 95% CI [0.27, 1.55] p= 0.34) wasnot significantly different between USG-SCB and the other approaches combined, a subgroupanalysis indicated that the incidence of adverse events was significantly higher in USG-SCBcompared to ultrasound-guided infraclavicular brachial plexus block (USG-ICB) and ultrasoundguided costoclavicular block (USG-CCB). However, the ultrasound-guided interscalene block(USG-ISB) was associated with a significantly higher incidence of adverse events than theUSG-SCB.Conclusions These study findings showed that the USG-SCB has not significantly different efficacy tothe other ultrasound-guided brachial plexus blocks. However, it is associated with a higherincidence of adverse events than the other blocks, apart from the USG-ISB. Therefore, thechoice of this method of regional anesthesia should be made by considering its advantages anddisadvantages.