Background. Distal arm surgery is widely performed under regional anesthesia with brachial plexus block. The preponderance\nof evidence for the efficacy relies upon injection of local anesthetic in excess of 30 mL. We aimed to compare three different\nultrasound-guided brachial plexus block techniques restricting the total volume to 20 mL. Methods. 120 patients were prospectively\nrandomized to ultrasound-guided brachial plexus block with 20mL ropivacaine 0.75% at either the supraclavicular, infraclavicular,\nor axillary level. Multiinjection technique was performed with all three approaches. Primary outcome measure was performance\ntime. Results. Performance time and procedural pain were similar between groups. Needle passes and injection numbers were\nsignificantly reduced in the infraclavicular group (P < 0.01). Nerve visibility was significantly reduced in the axillary group\n(P = 0.01). Success-rate was significantly increased in the supraclavicular versus the axillary group (P < 0.025). Total anesthesiarelated\ntime was significantly reduced in the supraclavicular compared to the infraclavicular group (P < 0.01). Block duration\nwas significantly increased in the infraclavicular group (P < 0.05). No early adverse effects occurred. Conclusion. Supraclavicular\nand infraclavicular blocks exhibited favorable characteristics compared to the axillary block. Supraclavicular brachial plexus block\nwith the multiinjection intracluster technique exhibited significantly reduced total anesthesia-related time and higher success rate\nwithout any early adverse events.
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