Effectiveness of Supraclavicular vs. Interscalene Brachial Plexus Block on Duration of Analgesia and Postoperative Pain Scores

Abstract

Background: Regional anesthesia is pivotal in upper limb surgeries; supraclavicular and interscalene brachial plexus blocks remain critical in optimizing postoperative analgesia, pain control, and patient outcomes. Objective: This study aims to compare the effectiveness of supraclavicular versus interscalene brachial plexus blocks regarding duration of analgesia, postoperative pain intensity, hemodynamic stability, and block-related complications in upper limb surgeries. Methods: A prospective randomized controlled trial was conducted at the Department of Anesthesiology, Uttara Adhunik Medical College Hospital, between January 2023–June 2024. A total of 122 ASA I–II patients undergoing elective upper limb surgeries were enrolled. Patients were randomized into supraclavicular (n=61) and interscalene (n=61) groups. Standardized ultrasound guidance was applied. Primary endpoints were analgesia duration and postoperative pain scores (VAS). Results: Mean analgesia duration was significantly longer in supraclavicular group (11.8 ± 2.3 h) compared to interscalene (9.4 ± 2.6 h), p<0.001. Mean VAS at 6 h was 2.1 ± 0.9 vs. 3.4 ± 1.1, respectively (p<0.01). At 12 h, VAS remained lower in supraclavicular (3.6 ± 1.2) vs. interscalene (5.2 ± 1.5). Rescue opioid requirement was reduced in supraclavicular (18.0%) vs. interscalene (34.4%), relative risk reduction 47.7%. Hemodynamic stability showed no significant difference (p=0.41). Incidence of hemidiaphragmatic paresis was higher in interscalene (19.7%) vs. supraclavicular (6.5%), p=0.03. No pneumothorax occurred. Patient satisfaction was greater in supraclavicular group (92% vs. 78%, p=0.02). Conclusion: Supraclavicular brachial plexus block provides superior postoperative analgesia, lower pain scores, and reduced opioid need compared to interscalene, with fewer respiratory complications, suggesting a safer, more effective regional anesthesia technique.