“A COMPARATIVE STUDY OF ULTRASOUND GUIDED TECHNIQUE VERSUS PERIPHERAL NERVE STIMULATOR GUIDED TECHNIQUE IN INFRA-CLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB SURGERIES.”

Background: Extensive use of ultrasonography for block execution has increased the success of procedure due to direct visualization of anatomical structures. Infra-clavicular brachial plexus block can be an attractive alternative to supraclavicular nerve block for upper limb surgeries. The objective of our study was to assess and compare the efcacy and success rate of USG guided technique versus PNS technique in Infra-clavicular brachial plexus block. Material And Methods: 70 adult patients with age in the range of 18-60 years, weight 50-80 Kg, ASA Grade I & II posted for elective upper limb surgeries of hand, wrist, forearm and distal arm under infra-clavicular brachial plexus block. Group P (PNS)– Nerve stimulator guided Infraclavicular brachial plexus block. Group U (USG)– Ultrasound guided Infraclavicular brachial plexus block. Block execution time, sensory blockade, motor blockade and success rate were assessed. Assessment of sensory blockade was done by Hollmen scale whereas motor block assessment was done by Bromage Scale. Results: There was statistically signicant difference between the groups for block execution time, onset of sensory and motor blockade, time for complete sensory and motor block and success rate(p<0.05). Conclusion: We conclude that, Ultrasound guided infraclavicular nerve block has shorter block execution time, faster sensory and motor block onset, signicantly earlier complete sensory and motor blockade, higher success rate with lesser pricks and minimal complications and should be preferred over PNS technique.

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

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.3.16 ◽

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 ◽

Group Ii ◽

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

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

The Open Anesthesiology Journal ◽

10.2174/1874321801610010027 ◽

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 ◽

Vas Scores ◽

The Mean ◽

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.

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

Bioscience Reports ◽

10.1042/bsr20200084 ◽

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 ◽

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>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.

A comparison of ultrasound versus paresthesia technique for supraclavicular brachial plexus block

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20170111 ◽

2017 ◽

Vol 4 (1) ◽

pp. 198

Author(s):

Bidyut Borah ◽

Smita R. Engineer ◽

Kiran B. Patel

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Block ◽

Motor Blockade ◽

Ultrasound Guided ◽

Ultrasound Technique ◽

Sensory Blockade ◽

Upper Limb Surgery ◽

Patient Groups ◽

Background: Ultrasonography is a newer tool for identification of nerves in the practice of regional anaesthesia. Visualization of target structures and spread of drugs under direct vision and thus avoiding complications like pneumothorax, accidental intravascular injections are potential benefit of ultrasonography technique. Aim of the study was to examine the usefulness of ultrasound guided brachial plexus block and compare it with paresthesia technique with the believe that ultrasound guidance can shorten the onset as well as increase the duration of blockade..Methods: Eighty patients of either sex, 18-60 years, posted for upper limb surgery were divided into 2 groups according to the technique used to give block, group US (ultrasound technique) and group PA (paresthesia technique). Both the groups received 0.5 % bupivacaine 20 ml with 8 mg of dexamethasone.Results: There was notable difference between the patient groups with regard to initiation of motor blockade (10 min group US vs 11.1 min group PA, p <0.0156) and sensory blockade (5.16 min group US vs 6.96 min group PA, p <0.0001) also duration of motor blockade (1272.88 min in group US vs 899.25 min in group PA, p <0.0001) and sensory blockade (1343.88 min in group US vs 996.75 min in group PA, p<0.0001).Conclusions: Ultrasound guided supraclavicular brachial plexus blocks result in a higher success rate with respect to onset and duration of blockade with less incidence of complications compared to paresthesia technique.

Effect of dexamethasone as an adjuvant to 0.5% levobupivacaine in supraclavicular brachial plexus block for upper extremity surgeries

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20171822 ◽

2017 ◽

Vol 5 (5) ◽

pp. 1943 ◽

Cited By ~ 1

Author(s):

Kartheek Hanumansetty ◽

Hemalatha S. ◽

Gurudatt C. L.

Keyword(s):

Brachial Plexus ◽

Upper Extremity ◽

Upper Limb ◽

Postoperative Analgesia ◽

Motor Block ◽

Brachial Plexus Block ◽

Peak Effect ◽

Motor Blockade ◽

Background: The supraclavicular brachial plexus block has proven to be an important, safer and effective alternative to general anaesthesia in surgeries of upper extremity. Primary aim is to study the effect of addition of dexamethasone to levobupivacaine on postoperative analgesia and secondary objectives are to study onset, peak effect and duration of sensory and motor block in brachial plexus blockade in adult patients posted for upper limb surgeriesMethods: This prospective randomized clinical study was conducted on 60 patients of age 18 to 60 years posted for upper limb surgeries. They were randomly allocated into two groups of 30. In Control group LS (n=30) received Inj. Levobupivacaine 30ml and Inj. Normal saline 2ml. In Study group LD (n=30) received Inj. Levobupivacaine 30ml and Inj. Dexamethasone 2ml (8mg).Results: Both the groups were demographically comparable. Onset of sensory block and motor block in group LD and in group LS were similar (p>0.05). Mean duration of sensory and motor block in group LD was higher than in group LS (<0.001). Duration of postoperative analgesia was 21.20±3.23 hours in group LD and 10.24±1.57 hours in group LS (p<0.001).Conclusions: Dexamethasone added to levobupivacaine for brachial plexus block prolonged the duration of sensory, motor blockade and postoperative analgesia but did not alter the onset time, peak effect time of sensory and motor blockade.

A CLINICAL COMPARISON OF 0.75% ISOBARIC ROPIVACAINE WITH 0.5% ISOBARIC BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB SURGERIES

10.36106/paripex/1201660 ◽

2020 ◽

pp. 43-46

Author(s):

Kalyan Sarma ◽

Bandana Mahanta ◽

Prabir Pranjal Das

Keyword(s):

Brachial Plexus ◽

Upper Limb ◽

Motor Block ◽

Brachial Plexus Block ◽

Sensory Block ◽

Motor Blockade ◽

The Mean ◽

Group B ◽

Background: Regional anaesthesia and analgesia, has the potential to provide excellent operating conditions along with better and prolonged post-operative with pain relief with fewer side effects. As a result, it is becoming increasingly popular for ambulatory anaesthesia and for day care patients.. Among the commonly used local anaesthetics, lignocaine and bupivacaine, bupivacaine has significant cardiovascular and central nervous system toxicity. In addition, bupivacaine also has lesser differentiation between sensory and motor blockade post-operatively. Ropivacaine and levobupivacaine were developed to avoid the bupivacaine related toxicities. The clinical safety profile of ropivacaine seems to be more favourable than that of levobupivacaine. With this background the following study was conducted to evaluate the efficacy of ropivacaine 0.75% for brachial plexus block in upper limb surgeries and its clinical comparison with bupivacaine 0.5%. Aims and Objectives: To assess the efficacy and toxicity of ropivacaine 0.75% and bupivacaine 0.5% as potential agents for brachial plexus block for surgeries of the upper limb around and below the elbow. Settings and Design: prospective, comparative, randomized, single blinded clinical trial. Materials and Methods: After institutional ethical committee approval, 100 patients physical status ASA I & II, of either sex, between 18-60 years, weighing between 40-60 kgs posted for upper limb surgeries around the elbow, forearm and hand were divide into two groups of 50 patients each. Group R (Ropivacaine group) received 0.75% isobaric ropivacaine 30 ml in supraclavicular brachial plexus block. Group B (Bupivacaine group) received 0.5% isobaric bupivacaine 30 ml in supraclavicular brachial plexus block by using peripheral nerve stimulator. Vitals, sensory, motor and analgesia score at pre-defined intervals intra-operatively were noted. Onset of analgesia, sensory & motor blockade, total duration of post-operative pain relief (VAS ≥ 5) and time of demand of first rescue analgesic were also noted along with any intra-operative complications, if any. Statistical Analysis: All the results were expressed as Mean ± SD. Statistical analysis was performed using Unpaired Student’s t-Test. Statistical significance was considered with a p value of ≤ 0.05. Results: Demographic profile and duration of surgery were comparable among the two groups. The mean time of onset of sensory block, onset of motor block and onset of analgesia were significant (p<0.05) in group R as compared to group B. The mean duration of sensory block and duration of post-operative analgesia were comparable between the two groups. However, the mean duration of motor block was significantly lower (p<0.05) in group R as compared to group B. the baseline hemodynamic variables and requirement of first analgesic dose and other adverse events were equivalent in both the group. Conclusion: Ropivacaine when compared with Bupivacaine, has faster onset of analgesia, sensory & motor blockade, significantly lesser duration of motor blockade. Ropivacaine also provides satisfactory post-operative analgesia with a stable hemodynamic profile similar to Bupivacaine with no undue adverse effects.

A Comparative Study of Bupivacaine 0.5 % and Ropivacaine 0.75 % for Supra-Clavicular Brachial Plexus Block Using Nerve Locator for Elective Upper Limb Orthopaedic Surgeries

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/377 ◽

2021 ◽

Vol 10 (24) ◽

pp. 1825-1829

Author(s):

Amol Singam ◽

Punith M. Sirige

Keyword(s):

Brachial Plexus ◽

Upper Limb ◽

Brachial Plexus Block ◽

General Nature ◽

Motor Blockade ◽

Sensory Blockade ◽

Significant Difference ◽

BACKGROUND Regional anaesthesia has multiple advantages as compared to general anaesthesia for upper limb surgeries. Here in this study, we wanted to compare bupivacaine 0.5 %, commonly used anaesthetic with ropivacaine 0.75 % which has fewer side effects like cardiotoxicity for supraclavicular brachial plexus block. METHODS A study was performed on 60 ASA I & II patients aged between 18 and 75 years, undergoing upper limb elective surgeries under brachial plexus block using nerve locator. Beginning of sensory and motor block, general nature of block, and terms of sensory and motor blocks were assessed in the C5 to T1 dermatomes. RESULTS There was no statistically significant difference in the onset of sensory and motor blockade between ropivacaine 0.75 % and bupivacaine 0.5 %. Ropivacaine 0.75 % produced similar quality of motor and sensory blockade compared to 0.5 % bupivacaine. The time taken for maximum motor blockade with ropivacaine was comparable with that of bupivacaine 0.5 %. There was no statistically significant difference regarding the duration of analgesia with ropivacaine 0.75 % compared to bupivacaine 0.5 %. Duration of motor blockade with 0.75 % ropivacaine was comparable to that of 0.5 % bupivacaine. CONCLUSIONS Ropivacaine 0.75 % 0.4 ml / kg or 0.5 % bupivacaine 0.4 ml / kg for supraclavicular brachial plexus block produces satisfactory and comparable sensory and motor blockade. It is suggested that lower cardiovascular toxicity of ropivacaine with equal efficacy as bupivacaine in such circumstances may help in reducing the risks to the patient. KEY WORDS Bupivacaine 0.5 %, Ropivacaine 0.75 %, Brachial Plexus Block, Upper Limb Orthopaedic Surgeries

Dexmedetomidine and Clonidine as an Adjuvant to Bupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block- A Randomised Clinical Trial

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49215.15445 ◽

2021 ◽

Author(s):

Yuvaraj Shastri ◽

Nanjappa Nagaraju ◽

MS Priyanka

Keyword(s):

Brachial Plexus ◽

Motor Block ◽

Brachial Plexus Block ◽

Randomised Clinical Trial ◽

Ultrasound Guided ◽

Sensory Blockade ◽

Group I ◽

Group Ii ◽

Introduction: Alpha‑2 agonists are used as adjuvants with Local Anaesthetic (LA) agents to prolong the duration of regional nerve blocks. Aim: To compare clonidine and dexmedetomidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor block and duration of analgesia. Materials and Methods: In this randomised clinical trial, 70 American Society of Anesthesiologists (ASA) class I and class II patients, scheduled for elective upper limb surgeries under ultrasound guided supraclavicular brachial plexus block, were divided into two equal groups. Group‑I received clonidine 1 μg/ kg and group‑II received dexmedetomidine 1 μg/kg added to bupivacaine 0.5% (20 mL). Onset and recovery time of sensory and motor block, duration of analgesia were studied in both the groups. Data analysis was done using Analysis of variance (ANOVA) and Student t‑test for analysis of continuous data and Chi‑square test used to know the difference of significance in categorical data. Results: A total of 70 subjects between age group of 18‑60 years were included in the study. The onset of sensory blockade was faster in group‑I (3.54±0.74 min) than group‑II (3.86±0.88 min) but statistically not significant. The onset of motor blockade was faster in group‑I (5.4±1.12 min) than group‑II (6.34±1.14 min) and difference was statistically significant. Duration of sensory blockade was longer in group‑I (616.23±62.05 min) than group‑II (574.71±61.14 min) and motor blockade in group‑I (635.86±57.82 min) was longer than group‑II (562.80±66.89 min) and the differences were statistically significant. The duration of analgesia was longer in group‑I (797.29±108.06 min) than group‑II (695.00±91.14 min) and the difference was statistically significant. Conclusion: Dexmedetomidine shortens the onset, prolongs the duration of sensory and motor block and also provides longer postoperative analgesia as compared with clonidine when used as an adjuvant to bupivacaine in ultrasound guided supraclavicular brachial plexus block.

A comparative study between the effect of verapamil versus nalbuphine as an adjuvant in supraclavicular brachial plexus block

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00149-3 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Mohammed Ibrahim Khamis ◽

Ahmed Saeed Mohamed ◽

Hesham Mohamed El Azazy ◽

Hala Salah El Ozairy ◽

Mohamed Moien Mohamed

Keyword(s):

Comparative Study ◽

Brachial Plexus ◽

Normal Saline ◽

Motor Block ◽

Brachial Plexus Block ◽

Sensory Block ◽

Motor Blockade ◽

Group A ◽

Group B ◽

Abstract Background Brachial plexus block has substituted general anesthesia in the majority of patients planned for upper limb surgeries as it avoids the undesired effects of the medications used in general anesthesia as well as the stress response associated with airway manipulation. Opioid agonist–antagonists such as nalbuphine are used as adjuvant to improve the anesthetic properties of bupivacaine. Verapamil has an additive effect in brachial plexus blockade in the form of decreasing the consumption of analgesics in the postoperative period with reducing onset time and extending the duration of motor and sensory blockade. The aim of this study is to investigate the adjuvant effect of verapamil versus nalbuphine to 0.5% bupivacaine in brachial plexus block as regards onset, duration of sensory and motor blockade and postoperative analgesic augmentation. The study is randomized, prospective, double-blinded, comparative study where 90 patients subjected to arm, forearm and hand surgeries were randomized into three groups, group A received 30 ml of plain bupivacaine 0.5% plus 2 ml of normal saline, group B received 30 ml of bupivacaine 0.5% plus 2 ml verapamil equivalent to 5 mg, group C received 30 ml of bupivacaine 0.5% plus 10 mg of nalbuphine diluted in 2 ml of normal saline. Results Results of this study showed that group C and group B sensory block time onset was 7.25 ± 1.5 vs. 10.92 ± 3.84 min, P < 0.001 and was shorter than that in group A (13.2 ± 2.66 min). In addition, the motor block onset was (11.10 ± 1.24 vs. 13.50 ± 3.77 min, P < 0.001) shorter than group A (17.16 ± 1.30 min). In group C and group B, sensory block duration was 396 ± 32.17 vs. 355.83 ± 18.48 min, P < 0.001, respectively and was longer than that in group A (321.13 ± 25.08 min). Also, there was prolonged motor block duration in group C and group B recording (338.92 ± 25.2 vs. 302.93 ± 15.24 min, P < 0.001) and was longer than that in group A (280.70 ± 32.35 min). Time of demand of rescue analgesia dose was significantly long in group C and group B (449.53 ± 52.45 vs. 418.13 ± 41.12 min, P < 0.001) and was longer than group A (361.31 ± 21.42 min). Both verapamil and nalbuphine have additive effect to bupivacaine improving the all anesthetic parameters of the block. Conclusion Both drugs produce favorable enhancement of time onset and effective prolongation of duration of sensory and motor blockade and extend the period of postoperative analgesia with superiority to nalbuphine over verapamil.

Ultrasound guided interscalene brachial plexus block via lower approach for upper limb surgeries

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20183913 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1304

Author(s):

Roopal R. Garaniya ◽

Sheetal Shah ◽

Noopur Prajapati

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Ulnar Nerve ◽

Upper Limb ◽

Brachial Plexus Block ◽

Interscalene Block ◽

Ultrasound Guided ◽

Peripheral Nerve Stimulator ◽

Interscalene Brachial Plexus Block ◽

Background: Brachial plexus block via interscalene approach is an excellent option for upper limb surgeries, but due to sparing of ulnar nerve (lower trunk, C8-T1) and its’ complications, it is not so popular. To overcome this problem, interscalene block via lower approach has been tried which has more advantage in view of ulnar nerve blockage and also less complications. In addition, ultrasound provides reliability, ease, rapidity and also patient comfort during block procedure. This prospective study was performed to evaluate the anaesthetic effect of lower approach interscalene block with the help of ultrasound and peripheral nerve stimulator.Methods: Ultrasound guided interscalene brachial plexus block via lower approach was given in randomly selected 30 patients, undergoing upper limb orthopaedic surgeries. After localisation of brachial plexus with ultrasound, the nerve roots were confirmed with the help of peripheral nerve stimulator, before injecting drug. At 5 and 15 min after block, all patients were assessed for the effect. Postoperatively they were assessed for any complication and also for their satisfaction level by Likert’s scale.Results: In territories of ulnar, radial and musculocutaneous nerve there was 100% effect while in median nerve territory 92.8% motor block was there. There was no need of analgesics during intra operative period in any patient and there were no major complications with this approach.Conclusions: Ultrasound guided interscalene block via lower approach is an excellent alternative for upper limb surgeries over classical approach in view of ulnar nerve blockage without any major complication.