Study protocol
brachial plexus block
STERILE, PERIOSTEUM
The surgical procedure was as follows: after the patient was brought to the anaesthesia preparation room, the venous channel was opened, and electrocardiogram, oxygen saturation values and blood pressure were monitored. All operations were performed under ultrasound guidance. Patients were grouped by anaesthesiologist: medical staff randomly allocated the patients into group I (SCPB and CPB) or group II (SCPB and ISBP) and placed the details of this group allocation in an envelope. Neither the patient nor the later researchers were aware of the group information. A nurse anaesthetist opened the envelope after obtaining the patient’s consent and then prepared regional anaesthesia drugs. All regional anaesthesia procedures were performed by the same anaesthesiologist.
Superficial cervical plexus block (SCPB): The patient was placed in a supine position with the head turned to the contralateral side for adequate exposure of the neck and the upper chest. The skin of the neck was disinfected by antiseptic solution. A linear high-frequency ultrasound probe (6–13 MHz, Sonosite) was placed at the lateral side of the neck over the midpoint of the sterno-cleido-mastoid muscle at the level of cricoid cartilage, which corresponds with the C6 transverse apophysis and its characteristic anterior tubercle. Once the muscle was identified, the probe was then moved posteriorly until the posterior tapering edge of the muscle was identified where the interscalene groove between the anterior and middle scaleni muscles was identified. Then, the superficial cervical plexus (SCP) was visualized just superficial to the prevertebral fascia overlying the interscalene groove. A five-cm block needle was then introduced from lateral to medial using the posterior-in-plane technique until its tip was placed near the SCP above the prevertebral fascia. After careful negative aspiration to exclude intravascular placement, 7 mL of 0.5% ropivacaine was deposited.Clavipectoral fascial plane block (CPB): The patient was placed in a supine position with the head turned to the contralateral side, and the shoulder was padded with a small pillow. Under sterile aseptic conditions, a 6- to 13-MHz linear array probe was used for regional anaesthesia. A local anaesthetic solution of 20 mL 0.5% ropivacaine was used for regional anaesthesia. During CPB, an ultrasound probe was placed on both the inner and outer one-third of the anterior surface of the clavicle. Using the in-plane technique, a 22-gauge needle was inserted and advanced into the space between the periosteum of the clavicle and clavipectoral fascia in a caudal to cephalad direction, and a total of 20 mL of 0.5% ropivacaine was equally injected medially and laterally. The ultrasound landmarks and the in-plane needle path are shown in Fig. Ultrasound image of clavipectoral fascial plane block
A 20-G needle was inserted using the in-plane technique from the caudal to cephalic direction.Ropivacaine was injected between the periosteum of the clavicle and the surrounding fascia.The spread of the local anaesthetic.
Interscalene brachial plexus block (ISBP): The patient was placed in a supine position with the head turned to the contralateral side, and the shoulder was padded with a small pillow. Under sterile aseptic conditions, a 6- to 13-MHz linear array probe was used for regional anaesthesia. To perform ISBP, the high-frequency probe was positioned at the level of cricoid cartilage to visualize the brachial plexus between the anterior and middle scalene muscles. ISBP was performed with a 21-gauge short bevel needle using an in-plane technique. A total of 20 mL of 0.5% ropivacaine was injected into every 5-mL aliquot after negative aspiration, and the needle was adjusted to achieve its spread between the C5 and C6 nerve roots.A nurse anaesthetist (blinded to the patient allocation group) was responsible for evaluating the scale, recording research data and postoperative follow-up. The effect of the block was measured at 30 min in three areas: the sternoclavicular joint, midclavicle and acromioclavicular joint. If the effect was poor, the patient was changed to general anaesthesia and withdrawn from the study. At the beginning of the surgery, all patients were administered 0.05 mg/kg of midazolam.