Ultrasound-guided supraclavicular block for ulnar nerve block: Intertruncal and corner-pocket methods

When it comes to most upper limb procedures, supraclavicular block (SCB) is extremely successful; yet, it is linked to problems including pneumothorax and ulnar nerve sparing. The deep position of the lower trunk inside the neural clusters and the placement of nerve trunks close to the pleura are the primary causes of these difficulties. With fewer difficulties, precise local anaesthetic deposition under ultrasonographic (USG) supervision may lessen the likelihood of ulnar nerve sparing and the need for local anaesthetics. The intertruncal approach, a more contemporary SCB procedure, blocks the brachial plexus's individual trunks. Researchers recently evaluated that the intertruncal technique produces a total blockage of the ulnar nerve.

Eighty-eight patients were randomly assigned to undergo SCB using an intertruncal or corner-pocket technique guided by ultrasound (USG). The primary focus of the comparison was the complete motor and sensory blockade of the ulnar nerve as well as all four nerves (ulnar, radial, median, and musculocutaneous nerves) at the 15-minute mark. The length of the ulnar nerve's sensory blockage, patient pain score, time to surgical readiness, and block performance time were all secondary goals. An independent t-test was used to compare continuous data, while a Chi-square test was used to analyse categorical data. At 15 minutes, the intertruncal group had a substantially larger percentage of patients with full sensory (30/44 vs. 14/44, P < 0.001) and complete motor (22/44 vs. 7/44, P < 0.001) blocks in the ulnar nerve and all four nerves. The intertruncal group had a greater block performance time and patient pain level (P < 0.001). In the corner-pocket group, there was a longer overall duration of sensory blockage in the ulnar nerve (P < 0.001).

The intertruncal method of USG-guided SCB had a considerably larger percentage of individuals with a full ulnar nerve blockage at 15 minutes than the USG-guided corner-pocket technique. For a better result of SCB regarding the ulnar nerve blocking, the intertruncal technique may be an option. In the current investigation, the intertruncal group's block performance time was noticeably longer. The longer block performance time in the intertruncal group may be explained by the need for ideal image conditions with all three trunks distinct in the intertruncal approach as opposed to the corner-pocket approach, where drug deposition is only required upon visualising SCA with the brachial plexus lateral to it.

Reference –

Trivedi, Saurabh; Gupta, Srishti1; Bhardwaj, Hemendra; Sahoo, Tapan Kumar; Gupta, Seema; Trivedi, Gaurav2. Efficacy of intertruncal and corner-pocket approaches of ultrasound-guided supraclavicular block in terms of ulnar nerve blockade: A randomised controlled study. Indian Journal of Anaesthesia 67(9):p 778-784, September 2023. | DOI: 10.4103/ija.ija_45_23.