Ultrasound-guided Supraclavicular Nerve Block In-plane Technique: Comparison of Conventional vs Skin Wheal Standoff Technique (original) (raw)
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Ultrasound Guidance Speeds Execution and Improves the Quality of Supraclavicular Block
Anesthesia & Analgesia, 2003
In this prospective study, we assessed the quality, safety, and execution time of supraclavicular block of the brachial plexus using ultrasonic guidance and neurostimulation compared with a supraclavicular technique that used anatomical landmarks and neurostimulation. It was hypothesized that ultrasonic guidance would increase the proportion of successful blocks, decrease block execution time, and reduce the incidence of complications such as pneumothorax and neuropathy. Eighty patients were randomized into two groups of 40, Group US (supraclavicular block guided in real time by a two-dimensional ultrasonic image, with neurostimulator confirmation of correct needle position) and Group NS (supraclavicular block using the subclavian perivascular approach, also with neurostimulator confirmation). Blocks were performed using bupivacaine 0.5% and lidocaine 2% (1:1 vol) with epinephrine 1:200,000 as the anesthetic mixture. The onset of motor and sensory block for the musculocutaneous, median, radial, and ulnar nerves was evaluated over a 30 min period. At 30 min 95% of patients in Group US and 85% of patients in Group NS had a partial or complete sensory block of all nerve territories (P ϭ 0.13) and 55% of patients in Group US and 65% of patients in Group NS had a complete block of all nerve territories (P ϭ 0.25). Surgical anesthesia without supplementation was achieved in 85% of patients in Group US and 78% of patients in Group NS (P ϭ 0.28). No patient in Group US and 8% of patients in Group NS required general anesthesia (P ϭ 0.12). The quality of ulnar block was significantly inferior to the quality of block in other nerve territories in Group NS, but not in Group US; the quality of ulnar block was not significantly different between Groups NS and US. The block was performed in an average of 9.8 min in Group NS and 5.0 min in Group US (P ϭ 0.0001). No major complication occurred in either group. We conclude that ultrasound-guided neurostimulator-confirmed supraclavicular block is more rapidly performed and provides a more complete block than supraclavicular block using anatomic landmarks and neurostimulator confirmation.
Van Medical Journal
Introduction: Ultrasound (USG) guided supraclavicular block in upper extremity surgery is a popular approach. In recent years, many studies have been published on the perfusion index (PI) in the evaluation of block success. The main objective of this study is to evaluate the success and efficiency of the supraclavicular block with traditional methods (Pin-prick test, Modified Bromage Scale) and perfusion index. Materials and Methods: After the approval of the ethics committee (2018-11/01) was taken for the study; 30 volunteer patients who were 18-75 years old with American Society of Anesthesiologists (ASA) I-II scores undergoing a hand, forearm, arm surgery, were included in the study. In this prospective study; after ultrasound-guided supraclavicular block has been applied by injecting local anesthetic that consists of prilocaine 12.5 ml + bupivacaine 12.5 ml to all patients, sensory block was checked with pin-prick test every 3 minutes, motor block was checked by using modified Bromage scale every 2 minutes, hemodynamic parameters and PI values were recorded every 5 minutes. Times of motor block onset and total mot or block onset, sensory and motor block ending time, the duration of block technique, the time of first postoperative analgesia consumption and positivity time for pin-prick test were recorded. Results: When the measured perfusion index values were compared, the differences were significant. When we compared the PI values in pairs, the differences between basal and 5 th min, 10 th min, 15 th min, 20 th min, 25 th min, and 30 th min were significant. Positivity time for pin-prick test was 8.83 ± 2.70 min (minimum 5 minutes and maximum 15 minutes), motor block onset time was 6.7 ± 2.89 min (minimum 2 minutes and maximum 13 minutes), time of total motor block onset was 10.83 ± 3.07 min (minimum 6 minutes and maximum 19 minutes). In the 5 th minute PI values, an average increase of 148% was observed compared to basal PI values. Conclusion: As a result; the supraclavicular block provided faster sensory-motor block than other upper extremity blocks. It was concluded that the perfusion index was faster, more objective and simpler method than traditional methods in assessing the block success, due to vasodilatation that occurred before sensory and motor block.
International Journal of Medical Anesthesiology, 2020
Background and Aims-Ultrasonography guided supraclavicular block is presumed to have faster onset time and increased the success rates with a reduction of the local anaesthetic dose, and also low down the complication rates. Whether or not the use of USG can improve practitioner's ability to successfully perform a faster supraclavicular nerve block remains needs to be studied. Hence study proposes to compare nerve stimulator guided technique and ultrasound guided technique for supraclavicular nerve block in upper limb surgery. Methods-60 adult patients, who were ASA physical status I-II and scheduled for elective upper limb surgery, were studied prospectively. 30 patients in each group to receive a supraclavicular block using either Ultrasound guidance (group U) or Nerve stimulation guidance (group P). Both the groups were injected with inj. Bupivacaine 0.5% 15ml and 2% lignocaine-with epinephrine 1:200000 15ml (total volume, 30 mL). The groups were compared in terms of Onset of sensory and motor block, Block performance time, Block success rate; hemodynamic parameters, and complications. Paired t-test and two-independent samples t-test were used for analysis. A p-value <0.05 was considered statistically significant for all comparisons. Result-The mean block performance time for P group was 4.65 + 1.11 seconds while that of the U group was 3.41 + 0.88 seconds (p = 0.0001). The mean time of onset of sensory block was 9.45 + 3.21 minutes in P group versus 8.75 + 2.98 minutes in the U group (P = 0.4007). The mean time of onset of motor block was 10.65 + 2.62 minutes in P group versus 10.14 + 2.44 minutes in U group (p=0.4405). Block success was achieved in 25 patients in P group out of 30 (83.3%), while in U group, out of 30 only 2 patient did not achieve block success (93.3%) P = 0.68. The hemodynamic changes in the form of systolic and diastolic blood pressure, mean blood pressure, heart rate and oxygen saturation recorded every 5 min up to 30 minutes showed no significant difference. Conclusion-Ultrasonography is a faster to perform, more accurate modality to perform the supraclavicular block.
Acta Anaesthesiologica Scandinavica, 2009
Background: Ultrasound (US)-guided supraclavicular or infraclavicular blocks are commonly used for upper extremity surgery. The aims of this randomized study were to compare the block performance and onset times, effectiveness, incidence of adverse events and patient's acceptance of US-guided supraclavicular or infraclavicular blocks. We hypothesized that the supraclavicular approach, being more superficial and easier to visualize using a 10 MHz transducer, will produce a faster and a more extensive sensory block. Methods: One hundred and twenty patients were randomized to two equal groups: supraclavicular (S) and infraclavicular (I). Each patient received a mixture containing equal volumes of ropivacaine 7.5 mg/ml and mepivacaine 20 mg/ml with adrenaline 5 mg/ml, 0.5 ml/kg body weight (minimum 30 ml, maximum 50 ml). The sensory score (anaesthesia-2 points, analgesia-1 point and pain-0 point) of the seven terminal nerves was assessed every 10 min. Patients were declared ready for surgery when they had an effective surgical block-anaesthesia or analgesia of the five nerves below the elbow. Thirty minutes after the block, the unblocked nerves were supplemented. The block performance and latency times, surgical effectiveness, adverse events and patient's acceptance were recorded. Results: Significantly more patients in the I group were ready for surgery 20 and 30 min after the block. The mean block performance time was 5.7 min in the S group and 5.0 min in the I group (NS). Block effectiveness was superior in the I group: 93% vs. 78% in the S group (P 5 0.017). The S group patients had a significantly poorer block of the median and ulnar nerves, but a better block of the axillary nerve. Sensory scores at 10, 20 and 30 min were not significantly different. Thirty-two patients in the S group vs. nine patients in the I group experienced transient adverse events (Po0.0001). Patients' acceptance of the block was similar in both groups. Conclusions: Infraclavicular block had a faster onset, better surgical effectiveness and fewer adverse events. Block performance time and patients' acceptance of the procedure were similar in both groups.
IP Innovative Publication Pvt. Ltd., 2018
Background and Aims: Conventional technique of supraclavicular block is associated with direct injury to the vessels, nerves and pleura, which can be minimized with lateral approach. Here, we compared lateral with conventional approach supraclavicular block given for forearm surgeries. Materials and Methods: After getting approval from ethical scientific committee, SSG hospital, Vadodara, this randomized prospective single blinded study was conducted from October 2014 to October 2015. 60 patients of either gender between 18 to 60 years, of ASA grade I and II undergoing forearm surgeries were enrolled. Those who refused, having anatomical distortion or infection of local site and pregnant patients were excluded. After doing randomization by computer method, Group C (n=30) received conventional and Group L (n= 30) received lateral approach supraclavicular block using nerve locator and total 35 ml of Inj. Lignocaine with adrenaline (1:200000)7mg/kg, Inj. Bupivacaine 2 mg/kg with Inj. Sterile water was injected. Patients were evaluated for technical difficulty, characteristics of sensory and motor blockade, duration of postoperative analgesia and complications. Results: Statistical analysis was done using student ‘t’ test with Medcalc software. P<0> Conclusion: Lateral approach of supraclavicular block is a safe alternative to conventional approach. Keywords: Supraclavicular block, Forearm orthopaedic surgeries.
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2009
Purpose To report our experiences regarding the implementation of a combined ultrasound and nerve stimulation guidance technique for supraclavicular blockade in day-case hand surgery patients at our institution. Clinical features We retrospectively reviewed 104 patient charts from the first 6 months of our clinical practice of using this block approach for upper extremity surgery. Block success, completion and recovery time, post-block analgesia requirement, acute complication rate, and duration of hospital stay were evaluated and categorized based on the practitioner who performed the block (fellow/staff anesthesiologists and residents), as well as the body mass index of the patient (when available). During the performance of each block, the brachial plexus was viewed using a curvilinear probe, and the needle was advanced in-plane in an anterolateral-to-posteromedial direction. The plexus, needle, and spread of local anesthetic could be clearly visualized in each case. Surgical regional anesthesia was achieved in 94.2% of blocks. The block was the sole method of postoperative analgesia in 85.6% of patients, and the overall block completion time was 20.2 ± 9.2 min. There were no occurrences of clinical pneumothorax during the study period.
Bilateral ultrasound-guided supraclavicular block
Colombian Journal of Anesthesiology, 2012
Analgesic management in patients with bilateral trauma to the shoulder or the proximal third of the arm is difficult. The multimodal strategy based on the administration of local analgesics to the brachial plexus appears to be the most effective; however, there are risks associated with bilateral blocks, including phrenic nerve palsy, toxicity due to local anesthetics, and bilateral pneumothorax. These risks may be diminished using an ultrasound-guided supraclavicular approach to the brachial plexus. This paper describes the management of a patient with bilateral injury to the shoulder and the proximal third of the humerus. The patient is taken to bilateral humeral fixation surgery and develops severe post-operative pain which does not respond to high-dose opioids and anti-inflammatory agents. He is managed initially with bilateral ultrasoundguided supraclavicular block using a low volume of a local anesthetic followed by continuous administration of bupivacaine. Pain assessment was 2/10 at 24 h and 3/10 at 48 h.
International Journal of Pharmacology and Clinical Sciences, 2016
Background: Brachial plexus blockade is a time tested anesthetic technique for upper limb surgeries. Among the various approaches of brachial plexus block, supraclavicular block, once described as the "spinal of the arm," offers dense anesthesia of the brachial plexus for surgical procedures at or distal to the elbow. Landmark technique has been traditionally used for performing this block. But blind technique often requires multiple trial-and-error needle attempts, resulting in increase in procedure time, procedure-related pain and complications including pneumothorax, which is very risky. In developing countries like India, ultrasound is a relatively new technique and is increasingly being used for performing nerve blocks for acute as well as chronic pain procedures. Objective: We performed this study to evaluate safety and clinical usefulness of ultrasound technology for supraclavicular brachial plexus blocks. Methods: We included 60 adult patients of either sex undergoing surgeries for fracture of lower end of humerus or fracture of forearm bones. Patients were divided into two groups. In one group, surface landmark technique was used while in other group, supraclavicular nerve block was performed under ultrasound guidance by double injection technique. All patients received 10 ml each of 2% lignocaine with adrenaline, 10 ml 0.5% bupivacaine and 10 ml of saline. Surgery was started after confirming adequacy of block. Ineffective blocks were replaced with general anesthesia and insufficient pain control during surgery was supplemented with fentanyl. Results: There was no significant difference between patient groups with regard to demographic data. Supraclavicular plexus nerve block was placed in all 60 patients. Block failure was seen in 5 patients in landmark technique group and in one patient in USG group. The time of onset of sensory and motor block was shorter in USG group than landmark technique group. Intra-op analgesic was required in 5/30 patients in blind group and 3/30 patients in USG group. Post-op analgesia was for longer duration in USG guided group as compared to blind group. Conclusion: Ultrasound guidance is clinically very useful for supraclavicular brachial plexus block. It allows visualization of underlying structures, movement of needle and direct spread of local anesthetic and thus making the procedure safer and more effective.
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Use of ultrasound for brachial plexus block has improved the precision of drug deposition around the plexus and hence the quality of the block. But there has been debate whether single point technique or double point technique is superior. Our aim was to compare the two techniques for the onset, completeness and quality of the block. METHODS A prospective observational study was designed. 140 patients were equally divided into Group A and Group B containing 70 posted for elbow, forearm and wrist surgery. A drug solution of 30 ml was prepared using Ropivacaine 0.75% 15ml + Lignocaine 2% with adrenaline 10 ml + 5ml of normal saline. Group A received 30ml of drug at the lower end of brachial plexus at 7 O'clock position. Group B received 15 ml of drug at site mentioned above and 15 ml was given at the upper part of brachial plexus at 11 O'clock position. Parameters noted were time taken for giving block, onset and completeness of sensory and motor block, encircle time, total duration of block. Unpaired student t test used for comparing quantitative variables and Chi-square test for qualitative variables. p < 0.05 was considered statistically significant. RESULTS The time required for giving the block was more in Group B (198.57 19.56 sec) compared to Group A (151.53 14.37 sec) but the encircle time in Group B (16 3.32 min) was lesser than Group A (19.01 3.6 min). The time of onset and completion of sensory and motor block for musculocutaneous, radial, ulnar and median nerve was faster in Group B compared to Group A. Duration of block in Group A was 367 50.49 minutes, whereas in group B 388 49.98 minutes. CONCLUSIONS In ultrasound guided brachial plexus block, even though both techniques have satisfactory results, double point technique is superior to single point technique in terms of onset, completeness and duration of the block but in terms of simplicity in technicality single point technique has the upper hand.
Saudi Journal of Anaesthesia, 2016
Background: Unintentional intraneural injection under ultrasound guidance (USG) with fine caliber needles and lower success rate with large caliber Tuohy needles in supraclavicular brachial plexus block (SCB) have been reported. Materials and Methods: We undertook study to standardize the use of 20-gauge short versus blunt bevel needle for SCB. After approval of Institutional Ethics Committee and written informed consent, patients were randomized using computer-generated random number table to either of the two groups; blunt bevel needle group (n = 30): SCB under USG using 20-gauge Tuohy needle or short bevel needle group (n = 30): SCB under USG using 20-gauge short bevel needle. The primary outcome of the study was time to establishment of sensory and motor block of individual nerves, and secondary outcome was tolerability and any adverse effects. Results: The time to establishment of sensory and motor block in individual nerve territory was similar in both the groups. The complete sensory and motor anesthesia was achieved in 78.3% patients and complete sensory and motor anesthesia after supplementary block was achieved in 86.6% patients. Paresthesias during SCB were recorded in 15 patients. Out of these eight patients were of blunt bevel group and seven patients were of short bevel group. None of the patients experienced any neurological adverse effects. Conclusion: The establishment of sensory and motor blockade of individual nerves was similar to 20-gauge short and blunt bevel needle under ultrasound guide with no neurological adverse events.