Double-injection technique assisted by a nerve stimulator for ultrasound-guided supraclavicular brachial plexus block results in better distal sensory–motor block

2017 ◽  
Vol 34 (3) ◽  
pp. 127-134 ◽  
Author(s):  
Quehua Luo ◽  
Weifeng Yao ◽  
HaiHua Shu ◽  
Ming Zhong
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Injection Technique ◽  
Nerve Stimulator ◽  
Ultrasound Guided ◽  
Double Injection ◽  
Sensory Motor ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

scholarly journals Comparison between Single- and Double-Injection Technique for Ultrasound-Guided Supraclavicular Block: A Randomized Controlled Study

2021 ◽  
pp. 1-6
Author(s):  
Suresh Kumar Vallapureddy ◽  
Gajanan Fultambkar ◽  
V. Rajeswar Rao ◽  
Vinay Kukreja ◽  
Rammohan Gurram ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Local Anesthetic ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Demographic Data ◽  
Controlled Study ◽  
Injection Technique ◽  
Double Injection ◽  
Performance Time ◽  
Plexus Block

<b><i>Background:</i></b> The supraclavicular approach to brachial plexus block is a commonly employed regional anesthesia technique for providing surgical anesthesia and postoperative analgesia for patients undergoing upper limb fractures. With ultrasound (US) guidance, the success rate of the block is increased, and complications like pneumothorax and vascular puncture are minimized. The block can be performed using single injection at the corner pocket or double injection, that is, half of the drug at the corner pocket and the remaining half at the cluster of brachial plexus divisions. <b><i>Methods:</i></b> After institutional ethics committee approval, we randomized 40 patients scheduled with fractures for elective upper extremity surgery under US-guided supraclavicular brachial plexus block. Twenty patients received 30 mL of local anesthetic at the corner pocket (group SI), and 20 patients received 30 mL of local anesthetic using the dual-injection technique in divided doses (group DI). Demographic data, time to block performance, time to sensory and motor block, total anesthesia-related time (TART), block success, and failure were compared between both groups. <b><i>Results:</i></b> The demographic data were comparable between both groups. The DI group had a significantly faster onset than the SI group (<i>p</i> = 0.0172). There was a statistically significant lesser performance time in group SI than in group DI (<i>p</i> &#x3c; 0.034). The sensory and motor block achieved was comparable between both groups. <b><i>Conclusion:</i></b> The success rates in both the SI and DI techniques are comparable. The DI technique results in a faster onset and hence a shorter TART; however, it may not be clinically relevant.

scholarly journals Effect of Midazolam and 0.5% Levobupivacaine Combination in Ultrasound-guided Supraclavicular Brachial Plexus Block for Upper Limb Surgeries - A Clinical Study

2016 ◽  
Vol 10 (1) ◽  
pp. 27-33
Author(s):  
Bhawana Rastogi ◽  
Ankush Arora ◽  
Kumkum Gupta ◽  
Manish Jain ◽  
Vijendra Pal Singh ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Motor Blockade ◽  
Ultrasound Guided ◽  
End Points ◽  
Supraclavicular Brachial Plexus Block ◽  
Vas Scores ◽  
The Mean ◽  
Plexus Block

Background: The present study was designed to evaluate the hypothesis that midazolam as an adjuvant to levobupivacaine would safely enhance the duration of analgesia without any adverse effects when compared with levobupivacaine alone, in ultrasound-guided supraclavicular brachial plexus block. Primary end points were the duration of sensory and motor block and secondary end points were sedation score and any other complications. Patients and Method: Eighty consenting patients of both sexes, aged 18-60 years of ASA physical status I-II were randomized into two groups of 40 patients each. Patients in Group LS received 19 ml of 0.5% levobupivacaine with 1 ml normal saline and patients in Group LM received 19 ml of 0.5% levobupivacaine with 1ml midazolam (50µg/kg) for supraclavicular brachial plexus block using ultrasound guidance. Onset time and duration of sensory and motor blockade and VAS scores were assessed as primary end points. Hemodynamic changes, sedation or any other drug or technique related adverse effects were taken as secondary effects. Results: Onset of sensory and motor blockade was lower in patients of Group LM. The mean duration of sensory analgesia was significantly prolonged in patients of Group LM (537.6 ± 101.01 vs. 319.80 ± 87.09 mins). The mean duration of motor blockade was also significantly enhanced in patients of Group LM (405.0 ± 61.62 mins) compared to Group LS (274.8 ± 46.30 mins). VAS scores were higher in Group LS than group LM. Sedation scores were similar in both the groups. Conclusion: Midazolam with 0.5% levobupivacaine has effectively enhanced the duration of sensory and motor block without significant sedation and any other side effect.

scholarly journals Comparison of ultrasound-guided supraclavicular and costoclavicular brachial plexus block using a modified double-injection technique: a randomized non-inferiority trial

2020 ◽  
Vol 40 (6) ◽  
Author(s):  
Quehua Luo ◽  
Weifeng Yao ◽  
Yunfei Chai ◽  
Lu Chang ◽  
Hui Yao ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Absolute Difference ◽  
Injection Technique ◽  
Motor Blockade ◽  
Ultrasound Guided ◽  
Sensory Blockade ◽  
Promising Alternative ◽  
Double Injection ◽  
Plexus Block

Abstract Ultrasound-guided costoclavicular block (CC-approach) is a recently described brachial plexus block (BPB) and an alternative approach to the supraclavicular approach (SC-approach). The relevant sonoanatomy is analogous in terms of the brachial plexus and its adjacent artery for both approaches. In the present study, we hypothesized that the two approaches will result in similar block dynamics when used the modified double-injection (MDI) technique. One hundred and twelve patients were randomly allocated to receive either a SC- or CC-approach with MDI technique. In the CC group, half the volume was injected adjacent to the medial cord of the brachial plexus, the procedure was guided by ultrasound and verified by nerve stimulator, subsequently the second half was injected close to the lateral cord. In the SC group, the MDI technique was carried out as described in our previous study. Sensory and motor blockade of all four terminal nerves were assessed with a 3-point scale. The primary outcome was the proportion of complete sensory blockade at 15 min with a predefined non-inferiority margin of −13%. The proportion of subjects at 15 min was comparable between the SC group and the CC group (91 vs 87%, absolute difference: −3%). No significant differences were found for complete motor blockade and onset times of the individual nerves within 30 min, and block-related serious adverse events (all P&gt;0.05). We conclude that the MDI technique applied to a costoclavicular and supraclavicular block resulted in similar block dynamics. In addition, it may provide a promising alternative technique when considering the use of multipoint injection.

scholarly journals A Prospective Randomized Study to compare Levobupivacaine and Ropivacaine in Patients Undergoing Forearm Orthopaedic Surgeries under Ultrasound-Guided Supraclavicular Brachial Plexus Block

2021 ◽  
Vol 15 (7) ◽  
pp. 2075-2081
Author(s):  
Wasim Khursheed Mir ◽  
Vipin Kumar Varshney ◽  
Md Shahbaz Alam ◽  
Prateek Singh ◽  
G.S. Jheetay ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Randomized Study ◽  
Prospective Randomized Study ◽  
Ultrasound Guided ◽  
Onset Of Action ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: Brachial plexus block utilizing ultrasound imaging has now become either adjuvant to general anaesthesia (GA) or as a mainstay anaesthesia modality. There are fewer studies comparing the effects of ropivacaine and levobupivacaine for supraclavicular brachial plexus block. The aim of this study was to do a prospective randomized study to compare 0.5% Levobupivacaine and 0.5% Ropivacaine in patients undergoing forearm orthopaedic surgeries under Ultrasound-Guided Supraclavicular Brachial Plexus Block. Materials and Methods: A total of 56 patients were enrolled and randomized into two groups. Group R with 28 patients was given 30mL of 0.5% Ropivacaine and Group L with 28 patients were given 30 mL of 0.5% Levobupivacaine, drugs were used for giving supraclavicular block under ultrasound. Parameters assessed were onset and duration of sensory and motor block, duration of analgesia, and any adverse events. After administration of block, the block characteristics were assessed every 5mins till the onset of the complete blockade, then hourly till the effect of the block. Data between the groups were analysed using SPSS 25.0 software. Results: Demographically both the groups were comparable in the study. The study shows that there was a statistically significant difference in onset of sensory block in Levobupivacaine and Ropivacaine (7.54 mins ± 2.10 vs 8.55 mins ± 2.08), similarly there was the difference in onset of motor block in Levobupivacaine 12.95 mins ± 2.30 vs Ropivacaine 14.07 mins ± 2.22. The duration of analgesia was more in the group of patients Levobupivacaine (9.98 hours ± 4.88) Ropivacaine (8.03 hours ± 3.58) Conclusion: the onset of action of sensory and motor was early in Levobupivacaine group with faster recovery of motor function as compared to the equivalent dose of Ropivacaine. Levobupivacaine has a better profile in terms of duration of analgesia. Keywords: Brachial plexus block, ropivacaine, levobupivacaine, supraclavicular brachial plexus block, ultrasound guidance

SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK IN UPPER LIMB SURGERIES: ULTRASOUND-GUIDED VERSUS NERVE STIMULATORTECHNIQUE

2017 ◽  
pp. 104-108
Author(s):  
Van Tri Nguyen ◽  
Van Minh Nguyen
Keyword(s):  
Brachial Plexus ◽  
Success Rate ◽  
Upper Limb ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Ultrasound Guided ◽  
Group I ◽  
Supraclavicular Brachial Plexus Block ◽  
Group Ii ◽  
Plexus Block

Objective: To compare the onset and duration ofsensory and motor blockade,success and complications rate of these two techniques. Subjects and methods: One hundred and twenty patients undergoing upper limb surgeries at Hue Central Hospital from May 2016 to May 2017 were divided into two groups. Group I underwentultrasound-guided supraclavicular brachial plexus block, group II with nerve stimulator. Each group received 25ml levobupivacaine 0.5% and 1/200000 adrenalin. Results:The procedure time (9.82 ± 4.55 vs 14.73 ± 4.73 min), the onset of sensory (6.15 ± 1.60 vs 9.92 ± 2.88 min) and motor block (7.95 ± 1.05 vs 12.63 ± 2.15 min) in group I were significant shorter than in Group II (p < 0.05). The duration of sensory and motor block, (481.38 ± 116.66 vs 319.22 ± 143.14 min and 412.97 ± 107.32 vs 205.88 ± 48.96 min, respectively) were significant longer in group I than in Group II (p < 0.05). The success rate (98.3% vs 90%) and complication incidence (1.7% vs 8.4%) were comparable between two groups. Conclusion: Ultrasound guidance for supraclavicular brachial plexus blockade provided faster onset, longer duration of sensory and motor block, higher success rate with fewer complications in comparison withnerve stimulator technique Key words: brachial plexus block, ultrasound-guided

scholarly journals Effect of Dexmedetomidine as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block

2019 ◽  
Vol 2 (1) ◽  
pp. 48-54
Author(s):  
Sabin Gauchan ◽  
Samyukta Acharya ◽  
Dikshya Karki
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
P Value ◽  
Ultrasound Guided ◽  
Supraclavicular Brachial Plexus Block ◽  
Group B ◽  
Plexus Block ◽  
Group D

Introduction: The objective of this study was to evaluate the effect of 50μg dexmedetomidine on the onset and duration of block and duration of analgesia when used as an adjuvant to bupivacaine in ultrasound guided supraclavicular brachial plexus block. Methods: Eighty patients of ASA physical status I and II undergoing elective upper limb surgery under ultrasound guided supraclavicular brachial plexus block were randomly divided into two groups: Group D and Group B. Group D (n=40) received 19.5 ml of 0.5% bupivacaine with 0.5 ml (50 μg) dexmedetomidine. Group B (n=40) received 19.5 ml of 0.5% bupivacaine with 0.5 ml normal saline. Onset time of sensory and motor block, duration of sensory and motor block and duration of analgesia was recorded. Results: Onset time of sensory block (10.55±4.84 min in Group D vs 12.50 ±5.20 min in Group B) and motor block (15.85±5.9min in Group D vs 18.35±5.6min in Group B) though earlier in Group D as compared to Group B was not statistically significant (p value =.087 for sensory block and p value=.058 for motor block). The duration of sensory block (772.20 ±167.84 min in Group D vs 398.38 ±129.839min in Group B) and motor block (725.63±140.964min in Group D vs 361.88±128.764 min in Group B) was statistically significantly prolonged in Group D (p value= .000 for sensory and p value =.000 for motor block). The Duration of analgesia (845.93±184.545min in Group D vs 430.04±121.307 min in Group B) was also statistically significantly prolonged in group D (p value= .000). Conclusions: Dexmedetomidine (50 μg) as an adjuvant to 0.5% bupivacaine solution in ultrasound guided supraclavicular brachial plexus block prolongs the duration (sensory and motor) of block as well as the duration of analgesia with no effect on the onset time of block. Keywords: brachial plexus block; bupivacaine; dexmedetomidine. Correspondance: Dr.

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