Title: Ultrasound or Nerve Stimulator Guided Interscalene Brachial Plexus Block: A Clinical Comparative Study Using 0.5% Levobupivacaine

Authors: Ivy Selina­­, Noopur Gusain, Malti Agrawal, Anand Prakash Verma, Gopal Krishan, Akash Gupta , Ankur Garg

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.213

Abstract

Objective: A clinical study to decide whether ultrasound or nerve stimulator guided Interscalene Brachial Plexus Block is the superior method.

Material and Methods: A single blind controlled study was done on 60 patients between the age group of 18-60 years of ASA grade I or II undergoing upper limb surgery. Group A received Interscalene Brachial Plexus Block with 30ml of 0.5% Levobupivacaine using nerve stimulator alone, whereas group B received the same using two-dimensional ultrasonic image, with the secondary use of nerve stimulator after securing a correct needle position. Onset, duration and quality of both sensory and motor blockade were studied in both the groups.

Results: The time spent for detecting the brachial plexus, attempts in needle positioning and time taken in injecting the local anaesthetic was not significantly different between the groups. There was no significant difference in onset of sensory and motor blockade between two groups. The only significant difference was in the duration of the sensory and motor blockade. The mean duration of sensory blockade was 520.83 ± 11.60 minutes in group A and it was 585.96 ± 6.24 minutes in group B. Similarly the mean duration of motor blockade in group A was 415.6 ± 10.72 minutes and it was 474.6 ± 20.63 minutes in Group B.

Conclusion: It was concluded that ultrasound guidance in administering Interscalene Brachial Plexus Block prolongs the duration of sensory and motor blockade without any hemodynamic disturbances if the blocks are performed by anaesthesiologist who are experienced in both techniques.

Keywords: Levobupivacaine, Nerve Stimulator, Ultrasound, Interscalene brachial plexus block, Sensory and motor blockade.

References

  1. Hadzic A, Vloka JD. Peripheral nerve blocks: principles and practice. New York: McGraw-Hill; 2004 Sep 20.
  2. Bridenbaugh LD. The upper extremity: somatic blockade. Neural blockade in clinical anaesthesia and management of pain. Philadelphia: JB Lippincott. 1988:387-416.
  3. Hirschel G. Die Anaesthesierung des Plexus Brachialis bei Operationenan der oberen Extremitat, Munchen med. Wshr. 1911; 58:1555-6.
  4. Kulenkampff D. Zuranästhesierung des plexus brachialis. ZentralblChir. 1911; 38:1337-50.
  5. Larson MD: History of Anaesthesia. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL. Anesthesia E-Book. Elsevier Health Sciences; 2009 Jun 24.
  6. Winnie AP. Interscalene brachial plexus block. Anesthesia& Analgesia. 1970 May 1;49(3):455-66.
  7. Meier G, Bauereis C, Maurer H, Meier T.InterskalenärePlexusblockadeAnatomischeVoraussetzungen–anästhesiologische und operative Aspekte. Der Anaesthesist. 2001 May 1;50(5):333-41.
  8. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. British journal of anaesthesia. 2004 Jul 26;94(1):7-17.
  9. Tsui B. Ultrasound-guidance and nerve stimulation: implications for the future practice of regional anaesthesia. Canadian Journal of Anesthesia/Journal canadiend' anesthésie. 2007 Mar 1;54(3):165-70.
  10. Schwemmer U, Schleppers A, Markus C, Kredel M, Kirschner S, Roewer N. Operative management in axillary brachial plexus blocks: comparison of ultrasound and nerve stimulation. Der Anaesthesist. 2006 Apr;55(4):451-6.
  11. Raj PP, Rosenblatt R, Montgomery SJ. Use of the nerve stimulator for peripheral blocks.Regional Anesthesia and Pain Medicine. 1980 Apr 1;5(2):14-21.
  12. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, Van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. Bmj. 2000 Dec 16;321(7275):1493.
  13. Beattie WS, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesthesia& Analgesia. 2001 Oct 1;93(4):853-8.
  14. Buist RJ. A survey of the practice of regional anaesthesia.Journal of the royal society of medicine. 1990 Nov;83(11):709-12.
  15. McCartney CJ, Brull R, Chan VW, Katz J, Abbas S, Graham B, Nova H, Rawson R, Anastakis DJ, von Schroeder H. Early but no long-term benefit of regional compared with general anaesthesia for ambulatory hand surgery. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2004 Aug 1;101(2):461-7.
  16. Chan VW, Peng PW, Kaszas Z, Middleton WJ, Muni R, Anastakis DG, Graham BA. A comparative study of general anaesthesia, intravenous regional anaesthesia, and axillary block for outpatient hand surgery: clinical outcome and cost analysis. Anesthesia& Analgesia. 2001 Nov 1;93(5):1181-4.
  17. Aromaa U, Lahdensuu M, Cozanitis DA. Severe complications associated with epidural and spinal anaesthesias in Finland 1987–1993 A study based on patient insurance claims. Acta Anaesthesiologica Scandinavica. 1997 Apr;41(4):445-52.
  18. Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2004 Oct 1;101(4):950-9.
  19. Brull R, Perlas A, Chan VW. Ultrasound-guided peripheral nerve blockade.Current pain and headache reports. 2007 Mar 1;11(1):25-32.
  20. Enneking KF, Chan V, Greger J, HadžicA, Lang SA, Horlocker TT. Lowerextremity peripheral nerve blockade: essentials of our current understanding. Regional anaesthesia and pain medicine. 2005 Jan 1;30(1):4-35.
  21. Greher M, Kapral S. Is regional anaesthesia simply an exercise in applied sonoanatomy? Aiming at higher frequencies of ultrasonographic imaging.Anesthesiology: The Journal of the American Society of Anesthesiologists. 2003 Aug 1;99(2):250-1.
  22. Klaastad Ø, Smedby Ö. The supraclavicular lateral paravascular approach for brachial plexus regional anaesthesia: a simulation study using magnetic resonance imaging. Anesthesia& Analgesia. 2001 Aug 1;93(2):442-6.
  23. Williams SR, Chouinard P, Arcand G, Harris P, Ruel M, Boudreault D, Girard F. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesthesia& Analgesia. 2003 Nov 1;97(5):1518-23.

Corresponding Author

Dr Gopal Krishan

Associate Professor, Department of Anaesthesiology, RMCH Bareilly (U.P.) India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Telephone No: 8979341741