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Vol. 68. Issue 7.
Pages 392-407 (August - September 2021)
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Vol. 68. Issue 7.
Pages 392-407 (August - September 2021)
Review
Complications associated with three brachial plexus blocking techniques: Systematic review and meta-analysis
Complicaciones asociadas a tres técnicas de bloqueo del plexo braquial: revisión sistemática y metaanálisis
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F.D. Casas-Arroyavea,
Corresponding author
fabian.casas@udea.edu.co

Corresponding author.
, E. Ramírez-Mendozab, A.F. Ocampo-Agudelob
a Hospital Universitario San Vicente Fundación, Departamento de Cirugía, Sección de Anestesiología, Universidad de Antioquia, Medellín, Colombia
b Hospital Universitario San Vicente Fundación, Sección de Anestesiología, Universidad de Antioquia, Medellín, Colombia
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Table 1. Characteristics of the studies included in the review.
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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:
Brachial plexus block
Supraclavicular block
Infraclavicular block
Axillary block
Anaesthetic complications
Resumen
Antecedentes

El bloqueo de plexo braquial se ha convertido en una de las técnicas anestésicas más usadas en el mundo para la anestesia del miembro superior. Para su realización se cuenta con tres diferentes técnicas: bloqueo supraclavicular, infraclavicular y axilar. Sin embargo su ejecución no está exenta de posibles complicaciones clínicas, y no es claro cual de estas se asocia a menor tasa de complicaciones y mayor éxito anestésico.

Materiales y métodos

Revisión sistemática y metaanálisis siguiendo la guias Cochrane y Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) para la identificación de de ensayos clínicos controlado en donde se compararan las tres técnicas antésicas de miembro superior. El desenlce principal fue incidencia de complicaciones anestésicas, y los secundarios fueron éxito anestésico, tiempo de realizacion y latencia anestésica.

Resultados

25 ensayos clínicos controlados, con 2012 paciente, fueron incluidos. La calidad metodológica de los estudios incluidos es de moderada a alta. Para el desenlace principal se encontró que la principal complicación reportada fue la punción vascular, seguida de la lesión neurológica transitoria, la parálisis diafragmática sintomática y el pneumotorax. No se encontró diferencias en complicaciones asociadas a las tres técnicas anestésicas. Adicionalmente, no se encontró diferencias en cuanto al éxito anestésico.

Conclusiones

Las complicaciones anestésicas asociadas a las tres técnicas de bloqueo braquial son bajas, sin secuelas a mediano y largo plazo; sin embargo, ninguna de las tres técnicas parece ser superior entre ellas para reducir dichas complicaciones. Las tres técnicas son altamente exitosas cuando se realizan mediante visualización ecográfica.

Palabras clave:
Bloqueo plexo braquial
Supraclavicular
Infraclavicular
Axilar
Complicaciones anestésicas

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