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Use of a curved needle to facilitate lateral sagittal infraclavicular block performance: a randomized clinical trial

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Abstract

Purpose

Failed needle-tip positioning in an ultrasound-guided infraclavicular block can be due to improper needle insertion point and steep needle insertion angle. Needle pre-curving enables the user to pass the needle with different curved trajectories on approaching the brachial plexus. Aim of the study was to compare curved and non-curved needles as regards the time needed to perform the lateral sagittal infra-clavicular block.

Methods

Sixty-nine patients undergoing surgery distal to the elbow were randomly allocated to two groups: group A (n = 35), which received ultrasound-guided infraclavicular block using the curved needle; and group B (n = 34), which received the infraclavicular block using the non-curved needle. The primary outcome measure was the time needed to perform the infraclavicular block. Anesthetist’s experience with the curved vs. non-curved needle was noted.

Results

Mean (SD) recognition time (120 ± 48 vs. 179 ± 72 s, P = 0.0002) and injection time (54 ± 23 vs. 88 ± 36 s, P = 0.0001) were shorter in group A compared to group B. Median (IQR) procedure pain score was less in group A 2 (1–2) than in group B 2 (2–3); P = 0.001. Median (IQR) satisfaction score was higher with regards to the curved needle 4 (4–5) than non-curved needle 3 (3–4) in performing infraclavicular blockade; P = 0.001.

Conclusion

The use of a curved needle reduces the time required to perform the lateral sagittal infraclavicular block. The curved needle provides less procedure pain and higher satisfaction levels among anesthetists than the non-curved needle.

Trial registration

The trial was registered (04/26/2016) with the ClinicalTrials.gov ID: NCT02799576. Approval Number: #2543. Board Name: Research Ethics Committee. Board Affiliation: Suez Canal University, Faculty of Medicine, Suez Canal University hospital, Ismailia, Egypt, 41522.

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Acknowledgements

The authors thank Youssef Tammam who helped us in preparation the template to process the needle in a standardized way and get the exact same needle contour curvature.

Funding

The authors have no sources of funding to declare for this manuscript.

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Authors and Affiliations

  1. Department of Anesthesia and Intensive Care, Faculty of Medicine, Suez Canal University Hospital, Ismailia, Egypt

    Tarek F. Tammam & Ghada A. Kamhawy

Authors
  1. Tarek F. Tammam
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  2. Ghada A. Kamhawy
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Contributions

TFT: Role: This author described and recommended the curved needle for technically easier infraclavicular block performance. The author was involved in the design of the study; analysis, interpretation of data and preparation of the manuscript. GAK: Role: This author was involved in the design of the study; analysis of data and preparation of the manuscript.

Corresponding author

Correspondence to Tarek F. Tammam.

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Tammam, T.F., Kamhawy, G.A. Use of a curved needle to facilitate lateral sagittal infraclavicular block performance: a randomized clinical trial. J Anesth 33, 604–611 (2019). https://doi.org/10.1007/s00540-019-02674-w

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  • DOI: https://doi.org/10.1007/s00540-019-02674-w

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