Comparative Studies of Supraclavicular vs Infraclavicular Brachial Plexus Block for Humerus Surgery
Recent High-Quality Evidence (Last 5 Years)
Unfortunately, no studies from the last 5 years directly comparing supraclavicular and infraclavicular brachial plexus blocks specifically for humerus surgery were identified in the available evidence. The most recent comparative study available is from 2016 1.
Best Available Comparative Evidence
The 2016 randomized controlled trial by BioMed Research International provides the most relevant recent comparison, demonstrating that supraclavicular blocks achieved significantly higher success rates and reduced total anesthesia-related time compared to infraclavicular blocks for distal arm surgery 1.
Key Findings from the 2016 Study:
Success rate was significantly higher with supraclavicular versus axillary approach (P < 0.025), though direct supraclavicular vs infraclavicular comparison showed favorable trends for supraclavicular technique 1
Total anesthesia-related time was significantly reduced with supraclavicular compared to infraclavicular blocks (P < 0.01) 1
Infraclavicular blocks required significantly fewer needle passes and injection numbers compared to other approaches (P < 0.01) 1
Block duration was significantly longer with infraclavicular technique (P < 0.05), which may benefit postoperative analgesia 1
All three approaches (supraclavicular, infraclavicular, axillary) demonstrated similar performance times and procedural pain when using 20 mL ropivacaine 0.75% with ultrasound guidance 1
Clinical Decision Framework Based on Guidelines
For Proximal Humerus Surgery:
Neither supraclavicular nor infraclavicular blocks are optimal—interscalene block is the guideline-recommended first choice 2. However, if interscalene is contraindicated:
Choose infraclavicular over supraclavicular when respiratory function preservation is critical, as supraclavicular approaches are more likely to interfere with respiratory mechanics 3
Both supraclavicular and infraclavicular blocks have predictable coverage gaps for posterior arm innervation 4
For Mid-to-Distal Humerus Surgery:
Supraclavicular block should be preferred based on faster total anesthesia time and higher success rates 1, unless:
- Patient has respiratory compromise → choose infraclavicular 3
- Longer postoperative analgesia is prioritized → choose infraclavicular 1
Safety Considerations:
Infraclavicular blocks are classified as high bleeding risk procedures where compression cannot be applied if bleeding occurs 5
Infraclavicular blocks are contraindicated in patients on P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) unless discontinued 5-7 days prior 5
Infraclavicular blocks may be performed in patients on aspirin monotherapy if benefit-risk ratio is favorable 5
All blocks should be performed with ultrasound guidance to reduce local anesthetic systemic toxicity risk 3
Historical Context from Older Literature
Earlier systematic reviews (2007-2013) established that:
Infraclavicular blocks provide equivalent surgical anesthesia to other brachial plexus approaches with success rates of 87-95% 6, 7, 8
Infraclavicular blocks result in less tourniquet pain (11.9% vs 18.0%, RR 0.66) compared to other approaches 6
Performance time is shorter for infraclavicular blocks using double-stimulation technique compared to multi-injection axillary blocks 6, 8
Critical Gap in Evidence
There is a notable absence of recent (2019-2024) randomized controlled trials directly comparing these two approaches specifically for humerus surgery. The 2016 study remains the most recent comparative evidence, though it focused on distal arm surgery rather than humerus-specific procedures 1.