Complications associated with three brachial plexus blocking techniques: Systematic review and meta-analysis

Rev Esp Anestesiol Reanim (Engl Ed). 2021 Aug-Sep;68(7):392-407. doi: 10.1016/j.redare.2020.10.003. Epub 2021 Jul 20.

Abstract

Background: Brachial plexus block has become one of the most widely-used anaesthetic techniques in the world for upper limb anaesthesia. There are three different brachial blocks techniques: supraclavicular, infraclavicular and axillary block. However, its execution is not exempt from possible clinical complications, and it is not clear which of these is associated with a lower complication rate and greater anaesthetic success.

Materials and methods: Systematic review and meta-analysis following the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify controlled clinical trials reporting the three techniques. The main outcome was the incidence of anaesthetic complications, and the secondary ones were an anaesthetic success, time of performance and anaesthetic latency.

Results: 25 controlled clinical trials, with 2012 patient, were included. The methodological quality of the included studies is moderate to high. For the main outcome, the main complication reported was a vascular puncture, followed by transient neurological injury, symptomatic diaphragmatic paralysis and pneumothorax. No differences were found in complications associated with the three anaesthetic techniques. Additionally, no differences were found regarding anaesthetic success.

Conclusions: Anesthetic complications associated with the three brachial block techniques are low, with no medium and long-term sequelae; however, none of the three techniques seems to be superior among them to reduce these complications. All three techniques are highly successful when performed using ultrasound imaging.

Keywords: Anaesthetic complications; Axilar; Axillary block; Bloqueo plexo braquial; Brachial plexus block; Complicaciones anestésicas; Infraclavicular; Infraclavicular block; Supraclavicular; Supraclavicular block.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Anesthesia*
  • Anesthetics, Local / adverse effects
  • Axilla
  • Brachial Plexus Block* / adverse effects
  • Brachial Plexus*
  • Humans

Substances

  • Anesthetics, Local