A Randomized Comparison Between Infraclavicular Block and Targeted Intracluster Injection Supraclavicular Block
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: This prospective, randomized trial compared ultrasound-guided targeted intracluster injection (TII) supraclavicular brachial plexus block (SCB) and infraclavicular brachial plexus block (ICB). METHODS: Sixty-four patients were randomly allocated to receive an ultrasound-guided TII SCB (n = 32) or ICB (n = 32). The local anesthetic agent (lidocaine 1.5% with epinephrine 5 μg/mL) was identical in all subjects. In the TII SCB group, half the volume (16 mL) was injected inside the largest neural cluster (confluence of trunks and divisions of the brachial plexus). Subsequently, the remaining half (16 mL) was divided into equal aliquots and injected inside every single satellite cluster. In the ICB group, the entire volume (35 mL) was injected dorsal to the axillary artery. During the performance of the block, the performance time, number of needle passes, procedural pain, and complications (vascular puncture, paresthesia) were recorded. Subsequently, a blinded observer assessed the onset time, incidence of Horner syndrome, and success rate (surgical anesthesia). The main outcome variable was the total anesthesia-related time (sum of performance and onset times). RESULTS: Due to a quicker onset [8.9 (5.6) vs 17.6 (5.3) minutes; P < 0.001], the total anesthesia-related time was shorter with TII SCB [18.2 (6.1) vs 22.8 (5.3) minutes; P < 0.001]. However no differences were observed between the 2 groups in terms of success rate (93.7%-96.9%), block-related pain scores, and adverse events such as vascular puncture and paresthesia. Expectedly, the ICB group required fewer needle passes (2 vs 6; P < 0.001) as well as shorter needling [4.8 (2.3) vs 9.0 (2.9) minutes; P < 0.001] and performance [5.6 (2.3) vs 9.5 (2.9) minutes; P < 0.001] times. Moreover, the ICB approach was associated with a decreased incidence of Horner syndrome (3.1% vs 53.1%; P < 0.001). CONCLUSIONS: Ultrasound-guided TII SCB and ICB provide comparable success rates. Due to its quick onset, TII SCB results in a shorter total anesthesia-related time.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".