scholarly journals Assessment of Duration of Analgesia after Supraclavicular Brachial Plexus Block Using Bupivacaine With and Without Intravenous Dexamethasone: A Comparative Observational Study

2021 ◽  
pp. 200-205
Author(s):  
Mohammed Muzammil ◽  
Aditya Sapra ◽  
Awadh Bihari Tiwari ◽  
H. N. Madhusudana ◽  
. Arti ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Tertiary Care ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Patient Comfort ◽  
Chi Square ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Aim: To compare and analyze the duration of analgesia after giving supraclavicular block using bupivacaine with and without intravenous dexamethasone. Methodology: The study was done in a tertiary care teaching hospital over 06 months. All eligible 50 patients were divided into two groups of 25 each. Group A patients receiving block by 40 ml of 0.25% bupivacaine were compared with Group B patients receiving 40 ml of 0.25% bupivacaine along with 8 mg intravenous dexamethasone. Duration of analgesia was calculated from the time of pain relief after block to the appearance of pain or Numerical Scale Rating (NRS) more than four. Any other complications were also noted. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 21, IBM Inc. As the data was found to be normally distributed bivariate analyses were performed using an independent t-test. Results: Mean duration of analgesia was found to be significantly more among subjects given Analgesia with bupivacaine and iv dexamethasone as compared to subjects given Analgesia with bupivacaine only as p<0.05. No significant difference was seen in the distribution of complications like nausea and vomiting among the two study group when compared using Chi-square test as p>0.05. Conclusion: In conclusion, the addition of dexamethasone supraclavicular brachial plexus block provides prolongation of the duration of the block and decreases the incidence of postoperative nausea and vomiting that may have a great impact on patient comfort.

Brachial Plexus Block with Ropivacaine, Effects of Added Alpha Adrenergic Agonists - Comparison between Clonidine and Epinephrine

2021 ◽  
Vol 8 (02) ◽  
pp. 97-102
Author(s):  
Pradeep Kumar Das ◽  
Raviteja Vallabha ◽  
Sri Harsha Merugu ◽  
Hemnath Babu Kotla
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Adrenergic Agonists ◽  
Sensory Blockade ◽  
Supraclavicular Approach ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
And Performance ◽  
Plexus Block

BACKGROUND To improve the time of regional anaesthesia many methods have been used. Epinephrine continues to be the most commonly used drug for this purpose. We wanted to compare the effects of alpha-adrenergic agonists clonidine and adrenaline as an adjuvant to ropivacaine in blocking brachial plexus by the supraclavicular approach in patients undergoing upper limb surgeries. METHODS It is a prospective randomised comparative study conducted for 18 months in 40 patients randomly divided into group RA and group RC, conducted on American Society of Anesthesiology (ASA) I and II patients undergoing upper limb surgeries under supraclavicular brachial plexus block. In group RA 30 mL of 0.5 % ropivacaine with 5 microgram / mL of epinephrine was given and in group RC 30 mL of 0.5 % ropivacaine with 1 microgram / Kg of clonidine was given. RESULTS On comparing effects of added alpha-adrenergic agonists clonidine and epinephrine to ropivacaine for supraclavicular brachial plexus block, it was found that there was no significant difference in the onset of the sensory blockade and motor blockade in the two groups. Duration of sensory blockade was significantly more in the clonidine with ropivacaine group when compared with the epinephrine and ropivacaine. There was no significant difference in haemodynamic responses between the two groups. CONCLUSIONS Supraclavicular approach brachial plexus block is effective in terms of cost and performance, and the margin of safety along with good postoperative analgesia. Hence, it can be concluded that the addition of 1 µg / Kg of clonidine to 0.5 % ropivacaine in supraclavicular brachial plexus block provides a longer duration of analgesia as compared to 5 µg / mL of epinephrine added to 0.5 % ropivacaine. KEYWORDS Ropivacaine, Supraclavicular Brachial Plexus, Epinephrine

scholarly journals COMPARISON OF FENTANYL AND DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK: A RANDOMIZED-DOUBLE BLIND PROSPECTIVE STUDY

2016 ◽  
Vol 9 (5) ◽  
pp. 74 ◽  
Author(s):  
Daisy Karan ◽  
Swastika Swaro ◽  
Swarna Banerjee
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Nerve Blocks ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Sensory Blockade ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

ABSTRACTObjectives: Supraclavicular block of brachial plexus provides complete and reliable anesthesia for upper limb surgeries. Using adjuvant to localanesthetics, blocks can be prolonged to long durations. Peripheral nerve blocks thus help in avoiding the hazards of general anesthesia. We comparedthe sensory blockade, motor blockade, and duration of analgesia with the addition of fentanyl or dexmedetomidine to bupivacaine for supraclavicularbrachial plexus block.Methods: A total of 50 American Society of Anesthesiologist’s Physical Status I and II patients scheduled for elective upper limb surgeries undersupraclavicular brachial plexus block were divided into two equal groups in a randomized double-blinded fashion. Group BF received 30 mlbupivacaine with fentanyl 50 µg and Group BD received 30 ml bupivacaine with dexmedetomidine 50 µg. The characteristics for anesthesia andanalgesia were assessed in both groups.Results: Duration of sensory and motor block was 363.4±38.36 minutes and 357±36.77 minutes, respectively, in Group BF while it was452.96±77.12 minutes and 441.52±48.46 minutes in Group BD. There was a statistically significant difference in onset of sensory and motorblock between the two groups. The duration of analgesia (time to requirement of rescue analgesia) in Group BD was longer than in Group BF(471.44±65.88 minutes vs. 366.48±38.02 minutes) with (p<0.0001). There were minimum hemodynamic disturbances and side effects in any groupexcept for Grade 3 sedation score which was more in Group BD.Conclusion: Dexmedetomidine, when added to bupivacaine in supraclavicular brachial plexus block, enhanced the duration of sensory and motorblock and also the duration of analgesia, more than when fentanyl was added to bupivacaine.Keywords: Fentanyl, Dexmedetomidine, Bupivacaine, Supraclavicular brachial block.

Comparative study of (0.5%) levobupivacaine and (0.75%) ropivacaine in supraclavicular brachial plexus block by lateral approach

2017 ◽  
Vol 5 (6) ◽  
pp. 2426
Author(s):  
Jitesh Kumar ◽  
. Sweta ◽  
Kumari Kanak Lata ◽  
B. K. Prasad ◽  
V. K. Gupta
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Lateral Approach ◽  
Controlled Study ◽  
Upper Limb Surgery ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: As compared to general anaesthesia, brachial plexus block for upper limb surgery gives fewer side effects and better postoperative analgesia. The objective of this study was to evaluate the effects of 0.5% levobupivacaine and compare it with 0.75% ropivacaine.Methods: For this prospective randomized, controlled study, 60 patients of both sexes of ASA grade 1 and 2 were enrolled and divided into two groups and supraclavicular brachial plexus block was performed by lateral approach using 30 ml of 0.5% levobupivacaine and 0.75% ropivacaine. The onset of sensory and motor block, duration of sensory and motor block and analgesia and possible adverse events were recorded.Results: No statistically significant difference was observed in the onset of sensory block in both groups. Onset of motor block was significantly faster in levobupivacaine group (P<0.05). Duration of sensory block, motor block and analgesia was significantly longer in levobupivacaine group (P<0.05).Conclusions: 0.5% levobupivacaine is better alternative to 0.75% ropivacaine in brachial plexus block in term of early onset of sensory block and long duration of analgesia.

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

Effect of Dexamethasone on The Duration of Analgesia for Supraclavicular Brachial Plexus Block

KYAMC Journal ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 199-203
Author(s):  
Md Rafiqul Islam ◽  
Laila Yesmin ◽  
Md Pervez Rahman ◽  
ABM Shafiul Anam Khan ◽  
Md Miraj Hossain ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Double Blind Study ◽  
Double Blind ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Group B ◽  
Plexus Block

Background: Brachial plexus block with Bupivacaine provides effective intraoperative anesthesia and analgesia. The use of dexamethasone along with local anesthetic has been shown to improve the duration of analgesia. Objective: To observe the effect of Dexamethasone on the duration of analgesia for Supraclavicular Brachial plexus block. Materials and Methods: A prospective, double-blind study was undertaken in patients scheduled for upper limb surgeries under supraclavicular brachial plexus block. patients were randomly divided into two groups, Group (BD) and B. Group B received 28 ml of 0.25% bupivacaine with 2 ml normal saline while Group BD received 28 ml of 0.25% bupivacain with 2ml (8mg) dexamethasone for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade. All the information was recorded in data collection sheet. Data was processed and analysed with the help of computer program SPSS and Microsoft excel. Results: There was no significant difference between groups in respect of demographic and American Society of Anaesthesiologist (ASA) status. Mean age was found to 34.7±8.53 years. In Group (BD) , 63.3% were ASA I and 36.6% were ASA II. In Group B, 60% were ASA I and 40% were ASA II. It has become evident that satisfactory anaesthesia can be made possible by addition of adjuvant to local anaesthetic in brachial plexus block (in Group-BD). onset of sensory block was faster in Group BD (8.17 ± 1.4 min) than Group B (9.12 ± 1.68 min). Similarly mean onset time of motor block in group A was 12.26 ± 3.96 min, and 11.58 ± 3.68 min in group B. Our study shows that duration of motor block was 408.68±26.96 min and 380.26 ± 24.11 min in group BD and Group B respectively. Conclusion: There was significantly prolonged duration of analgesia in addition of Dexamethasone without any unwanted effects. KYAMC Journal Vol. 11, No.-4, January 2021, Page 199-203

scholarly journals 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

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 ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

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

scholarly journals A comparative study to assess the efficacy of addition of dexmedetomidine to levobupivacaine in brachial plexus block

2021 ◽  
Vol 8 (2) ◽  
pp. 155-160
Author(s):  
Shabeel Aboobacker C P ◽  
Shamjith K ◽  
Melbin Baby ◽  
Salman Mohammed Kutty C
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Tertiary Care ◽  
Random Allocation ◽  
Duration Of Action ◽  
Upper Limb Surgery ◽  
Significant Difference ◽  
Plexus Block

Brachial plexus block is one of the best surgical technique for upper limb surgeries. It is a good anesthetic and analgesic agent. Though levobupivacaine has a duration of action of three to eight hours it has an acceptable analgesic property and few other practical constraints. Addition of vasoconstrictors like α-adrenergic agonists, hyaluronidase, neostigmine, opioids have been found to be effective. Dexmedetomidine, an α2 receptor agonist has found to be a better adjuvant to levobupivacaine by few literatures. To assess the effect of levobupivacaine 0.5% alone and with dexmedetomidine 100 μg as an adjuvant to levobupivacaine 0.5% on the onset and duration of sensory and motor block, the duration of perioperative analgesia, complications and sedation score.This study was conducted after ethical committee clearance in a tertiary care medical college hospital in northern Kerala, India. 60 patients between the age of 18 and 60 years planned for upper limb surgery under brachial plexus block, who fulfilled the inclusion and exclusion criteria were included in the study. A pre anesthetic checkup was done to assess the patient before including in the study. The patients who were included in the study were randomly assigned into two groups – one group received 1 ml (100µg) dexmedetomidine with 39 ml of 0.5% Levobupivacaine(LD group) and the second group received 1 ml of 0.9% normal saline and 39 ml of 0.5% Levobupivacaine(LS group) as anesthetic agent through sealed envelope technique. The clinical history, vitals and hemodynamic parameters were monitored and noted prior to and during the surgery. The data collected was analyzed and tabulated. There was no statistically significant difference between both groups with respect to age, Gender and weight signifying proper random allocation of study subjects. None in LD group required post operative analgesia. The mean duration of onset of sensory and motor block was earlier and duration of motor and sensory analgesia was prolonged with the addition of Dexmedetomidine to Levobupivacaine. The hemodynamic stability was better with Dexmedetomidine. Bradycardia was reported in 20% of study participants who were administered dexmedetomidine Dexmedetomidine added to levobupivacaine provides better anesthetic and analgesic care in upper limb surgeries done using brachial plexus block.

scholarly journals A Comparative Clinical Evaluation of Efficacy of Tramadol As An Adjuvant To Bupivacaine En Brachial Plexus Block For Upper Limb Surgery

2017 ◽  
Vol 13 (2) ◽  
pp. 13-16 ◽  
Author(s):  
Nabin Kumar Regmi ◽  
Sangeeta Subba ◽  
Uttam Chandra Sharma
Keyword(s):  
Brachial Plexus ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Nerve Blocks ◽  
Group I ◽  
Upper Limb Surgery ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: In peripheral nerve blocks, adjuvants are added to local anaesthetics to improve the quality of anaesthesia and analgesia. We designed this randomized single blinded prospective study to compare the analgesic efficacy of tramadol used as an adjuvant to bupivacaine for supraclavicular brachial plexus block in patients undergoing orthopaedic surgeries of upper limb.Aim of study: In this study, we aimed to compare onset, duration and quality of analgesia along with respiratory, hemodynamic changes with tramadol as adjuvant to bupivacaine in supraclavicular brachial plexus block in the patients undergoing upper limb surgery.Method: In this prospective randomized control trial, two groups of 30 patients each were investigated. 28 ml. of 0.5% bupivacaine (plain) with 2 ml. normal saline was administered in group - I and 28 ml. of 0.5% bupivacaine (plain) with 2ml. (100 mg.) tramadol was administered in group - II. The onset of sensory and motor block, duration of analgesia, respiratory/hemodynamic parameters and post-operatively quality of analgesia via visual analogue scale were assessed.Results: The duration and quality of analgesia was significantly increased by adding tramadol in bupivacaine than bupivacaine alone (p=<0.001 and <0.001) whereas there was no statistically significant difference in onset of motor (p=>0.35) and sensory block (p=>0.75) and also hemodynamic and respiratory parameters.(HR p=>0.1, MAP p=>0.5, and SPO p=>0.5).Conclusion: The study suggests that tramadol when added to bupivacaine 2 for supraclavicular brachial plexus block enhances the quality of anaesthesia and analgesia without affecting respiratory/hemodynamic parameters.JNGMC Vol. 13 No. 2 December 2015, Page: 13-16

scholarly journals A Comparative Study Between Two Different Doses of Dexmedetomidine Combined with Ropivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block

2018 ◽  
Vol 14 (3) ◽  
pp. 127-131
Author(s):  
Jeevan Singh ◽  
Samir Shakya ◽  
Anuranjan Ghimire ◽  
Sanjay Saha ◽  
Parikshit Bikram Singh
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
P Value ◽  
Double Blind ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block ◽  
Different Doses

Background: Though, various studies have been conducted to show the efficacy of            dexmedetomidine as an adjuvant to brachial plexus block, there is no clear consensus for its optimal dose. We compared 2 different doses of dexmedetomidine (1mcg/kg Vs 2mcg/kg) with ropivaciane in USG guided brachial plexus block for the quality of anesthesia and analgesia. Materials and Methods: Fifty patients (18-50years, 50-60kgs), ASA PS I and II undergoing surgery of upper limb were enrolled in this prospective, double blind, randomized control trial. Group Rd received 19ml of 0.5% Ropivaciane with 1mcg/kg  of dexmedetomidine (total 20ml), and Group RD received 19ml of 0.5% Ropivacaine with 2mcg/kg of dexmedetomidine (total 20ml). Onset and duration of sensory and motor block, duration of analgesia, sedation score, hemodyanamic changes were compared. We also monitored for various un towards effects. Results: The onset time of sensory and motor block (9.36±1.114 mins and 14.40 ± 1.528 mins in group Rd vs 8.32 ±0.945 mins and 12.40 ± 1.21 mins in group RD) were not significantly different between two groups (p-value > 0.05).The duration of sensory and motor block (596.20 ± 76.859 mins and 541.20±81.564 mins in group Rd vs 730.80 + 65.187 mins and 659.80±93.607 mins in group RD) were not significantly longer in group RD than group Rd (p-value > 0.05). The duration of analgesia (626.00±70.475 mins in group Rd vs 754.00±60.139 mins in group RD) were not significantly longer in group RD than group Rd (p-value > 0.05). Hemodynamic parameters were also comparable between two groups (p-value >0.05) but 3 patients in RD group (2mcg/kg) developed bradycardia and required treatment with atropine whereas in Rd group (1mcg/kg) none developed bradycardia. Conclusions: There is no significant difference in the onset and duration of block between the two groups. However, higher dose of    dexmedetomidine is associated bradycardia. Hence, in comparision with 2mcg/kg, 1mcg/kg of   dexmedetomidine is better adjuvant to 0.5% ropivaciane in terms of safety and effectiveness.Keywords: dexmedetomidine; ropivacaine; supraclavicular brachial plexus block. 

scholarly journals Ultrasound and Modern Regional Anaesthesia

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
T.V.S Gopal
Keyword(s):  
Brachial Plexus ◽  
Regional Anaesthesia ◽  
Ultrasound Guidance ◽  
New Technologies ◽  
Brachial Plexus Block ◽  
Patient Comfort ◽  
Preventive Cardiology ◽  
Time Motion ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Lazzaro Spallanzani, an 18th century Italian biologist, is credited with the discovery of ultrasound, which he coined ‘echolocation’. [1] Little may he have realized then that his revelation would transform into an all pervading technology in modern science. Though La Grange and colleagues, in 1978, were the first to employ ultrasonic blood flow detector to locate insertion point for the supraclavicular brachial plexus block, ultrasound guidance in real time motion was first utilized by S. Kapral et al for the same block in a series of forty patients in 1994, thus, heralding a fresh epoch in regional anaesthesia. [2, 3] As is often the case with the introduction of new technologies, ultrasound guidance was also met with cynicism and disdainful resistance. However, not much later, ultrasound guidance was being hailed as the ‘gold standard’ for regional anaesthesia, and it was proclaimed that the search for the elusive ‘holy grail’ had ended. [4] Among the first nerve/plexus blocks to find wider acceptance with the adoption of ultrasound guidance was the supraclavicular brachial plexus block. The fear of arterial puncture and accidental pneumothorax magically seemed to vanish into thin air. Correlation between clinical and sono-anatomy led to a better understanding of interscalene, infraclavicular and axillary approaches to the brachial plexus. [5] Lower limb blocks began to witness a renaissance due to the widespread prescription of antiplatelet drugs as part of preventive cardiology. Though deeper to the skin in comparison to the upper limb, ultrasound guidance improved identification of neural structures. It was reported in literature that ultrasound improves patient comfort, block acceptance, onset of block, quality of block, permits the injection of lower local anaesthetic volumes, and thereby, the potential for LAST, and reduces the incidence of certain complications that may be attributed to the block procedure. [6] However, given the resolution of current port

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