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

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 ◽  
Supraclavicular Brachial Plexus Block ◽  
Patient Groups ◽  
Plexus Block

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.

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

2021 ◽  
pp. 68-71
Author(s):  
Sonali M Khobragade ◽  
Roopa R
Keyword(s):  
Brachial Plexus ◽  
Success Rate ◽  
Upper Limb ◽  
Execution Time ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Motor Blockade ◽  
Ultrasound Guided ◽  
Sensory Blockade ◽  
Plexus Block

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.

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 A Comparative Study of Addition of Midazolam to Lignocaine—Bupivacaine vs only Lignocaine— Bupivacaine in Brachial Plexus Block

2016 ◽  
Vol 1 (1) ◽  
pp. 5-9
Author(s):  
Naina P Dalvi ◽  
Harshali Salunkhay ◽  
Shubha N Mohite
Keyword(s):  
Comparative Study ◽  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Control Group ◽  
Study Group ◽  
Motor Blockade ◽  
Peripheral Nerve Stimulator ◽  
Sensory Blockade ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

ABSTRACT Introduction This prospective, randomized, double-blind study compared the onset and duration of sensory blockade, motor blockade, and analgesia with lignocaine, bupivacaine, and midazolam combination vs only lignocaine, bupivacaine in brachial plexus block. Materials and methods Patients of either sex, aged 18–60 years, American Society of Anesthesiologists grade I/II, posted for upper limb surgeries to be performed under supraclavicular brachial plexus block with the help of peripheral nerve stimulator were administered either 10 ml 0.5% bupivacaine with 50 μg/kg midazolam (preservative free) + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine– bupivacaine–midazolam (LBM) or 10 ml 0.5% bupivacaine + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine–bupivacaine (LB). Onset and duration of sensory and motor blockade were monitored. Postoperative analgesia was graded with visual analog scale. Sedation was monitored with Ramsey sedation score. Results A total of 60 patients were randomized to the group LBM (n = 30) and group LB (n = 30). The analgesia was significantly prolonged in the study group, with a mean of 11.72 ± 1.924 hours as compared with a mean of 6.383 ± 1.031 hours in the control group. Sedation scores were higher in the study group, that is, group LBM compared to group LB postoperatively. Conclusion In conclusion, midazolam when added to bupivacaine and adrenalized lignocaine for supraclavicular brachial plexus block hastens the onset of sensory and motor blockade. This combination improves analgesia, as manifested by lower pain scores and prolonged duration of analgesia. How to cite this article Dalvi NP, Salunkhay H, Mohite SN. A Comparative Study of Addition of Midazolam to Lignocaine–Bupivacaine vs only Lignocaine–Bupivacaine in Brachial Plexus Block. Res Inno in Anaesth 2016;1(1):5-9.

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.

A rat model of nerve stimulator-guided brachial plexus blockade

2018 ◽  
Vol 53 (2) ◽  
pp. 160-168
Author(s):  
Yanzi Zhang ◽  
Bo Cui ◽  
Chunyu Gong ◽  
Yidan Tang ◽  
Jianxiong Zhou ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Rat Model ◽  
Local Anesthetics ◽  
Brachial Plexus Block ◽  
Motor Blockade ◽  
Efficacy And Safety ◽  
Nerve Stimulator ◽  
Sensory Blockade ◽  
Brachial Plexus Blockade ◽  
Plexus Block

It is important to develop a feasible animal model of regional anesthesia other than sciatic nerve blockade for pharmacokinetic investigations of new local anesthetics or analgesia in upper extremity surgery. Herein, we explored a nerve stimulator (NS)-guided brachial plexus block (BPB) in a rat model. The anatomy of the brachial plexus in rats was delineated in cadavers, and various BPBs were examined. The puncture point was located 0.5–1.0 cm below the lateral one-third of the clavicle. The efficacy and safety of the NS-guided BPB were evaluated using an injection of 2% lidocaine or 0.5% bupivacaine in 16 live animals; saline injection was used as a control. Both sides of the brachial plexus were located successfully using the NS-guided technique. Sensory blockade (nociception assessment) and motor blockade (grasping and straightening tests) appeared after application of the two classical local anesthetics, but not normal saline. The motor and sensory blockade induced by bupivacaine exhibited a longer duration than that induced by lidocaine ( p < 0.05). All rats recovered uneventfully from general anesthesia and BPB. No abnormal results were found in pathological studies or behavioral observations. Thus, a rat model of NS-guided BPB was established, and BPB induced an overall reversible sensory and motor blockade in the thoracic limbs. Evaluation of the efficacy and safety demonstrated that this rat BPB model was feasible, reproducible, and safe.

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