A Cochrane review [Abstract] 1 included 15 studies with a total of 1 020 subjects. Infraclavicular blockade (ICB) was compared with other brachial plexus blocks (BPBs). The control group intervention was the axillary block in 10 studies, mid-humeral block in 2 studies, supraclavicular block in 2 studies and parascalene block in 1 study. Three studies employed ultrasound-guided ICB. Two of these studies compared it to an ultrasound-guided supraclavicular block, while one study compared it to a multiple-injection neurostimulation-guided axillary block. All other studies used a combination of surface landmarks and neurostimulation to locate the brachial plexus.
There was no significant difference in the proportion of surgical anaesthesia at 30 minutes post-block: 85.3% of patients achieved surgical anaesthesia following ICB compared to 89.5% with all other blocks (RR of no surgical anaesthesia 1.39, 95% CI 0.93 to 2.08, 9 studies, n= 650). There was a higher risk of requiring supplementation following ICB compared to other blocks (15% versus 10.3%; RR of requiring supplementation 1.45, 95% CI 1.02 to 2.04, 11 studies, n=813). Subgroup analysis by time of block assessment found that supplementation was more likely following ICB when anaesthesia was assessed 30 minutes after block completion but not when assessment was done at 60 minutes. Tourniquet pain was less likely with ICB (RR 0.47, 95% CI 0.24 to 0.92; 5 studies, n=359). There was no difference between infraclavicular block and other blocks in the reported complications (RR 0.84, 95% CI 0.56 to 1.27; 15 studies, n=3472).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinfing).
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