Keywords
ultrasonography
bupivacaine
regional anesthesia
How to Cite
Abstract
In press
Background. Brachial plexus block is a widely used regional anesthesia technique for upper-extremity surgery, although a clinically relevant proportion of blocks remain ineffective. The outcome may be influenced by patient characteristics, the approach, the block technique, and the volume of local anesthetic.
Aim. To determine the factors affecting the effectiveness of upper-extremity block using supraclavicular, infraclavicular, and axillary approaches during surgical treatment of the distal humerus, elbow, forearm, and hand.
Materials & Methods. A pilot observational study included 60 patients aged 25–60 years who underwent surgery in 2022–2025. All patients had American Society of Anesthesiologists physical status class I or II. Brachial plexus blocks were performed under ultrasound guidance using 0.5% bupivacaine. Frequencies were compared using Fisher's exact test or its extension for larger contingency tables; mean local-anesthetic volumes were compared using Welch's t-test. Because only seven block failures occurred, multivariable analysis was not performed. The study was conducted within the research project of the Department of Anesthesiology, Intensive Care and Pediatric Anesthesiology of Kharkiv National Medical University "Features of anesthetic management of surgical interventions, intensive care strategies and pain medicine" (2024–2027), state registration No.0123U104848.
Research Ethics. The study was approved by the Commission on Ethics and Bioethics of Kharkiv National Medical University (protocol No.235 of September 29, 2025). All patients provided written informed consent to participate in the study and to undergo regional anesthesia.
Results. Block failure occurred in 7 of 60 patients (11.7%). Failure rates were 16.7% with the infraclavicular approach, 9.1% with the supraclavicular approach, and 7.1% with the axillary approach; the association between approach and block outcome was not statistically significant (p=0.677). No statistically significant association was found for sex (p=0.687), surgical site (p=0.156), or local-anesthetic volume (p=0.537). Conversion to general anesthesia occurred in 7 patients (11.7%).
Conclusions. In this pilot sample, no evidence of a statistically significant association was found between block failure and the analyzed factors. The small number of events does not exclude clinically important associations and limits the generalizability of the findings.
Keywords: anesthesiology, ultrasonography, bupivacaine, regional anesthesia.
References
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