SUPRA-CLAVICULAR BRACHIAL PLEXUS BLOCK: ULTRA-SONOGRAPHY GUIDED TECHNIQUE OFFER ADVANTAGE OVER PERIPHERAL NERVE STIMULATOR GUIDED TECHNIQUE

Abstract

Introduction: Brachial Plexus block is an excellent anaesthetic option of upper limb surgery. The age old “Blind Paresthesia” technique and Peripheral Nerve Stimulation (PNS) may require multiple trial and error, not only increases block performance time and delays onset of anaesthesia, but also carries risk of damage to nerves or surrounding. Use of ultrasound to perform peripheral nerve block is a relatively new technique that is rapidly gaining popularity.

Methodology: This study was conducted among 60 patients suffering from chronic renal failure with ASA III scheduled for the creation of arterio-venous fistula which needed brachial plexus block. In one group (n=30) ultrasonography (USG) guided technique was used and in second group (n=30) Peripheral Nerve Stimulation (PNS) guided technique was used. Various parameters including procedure time, onset time for sensory block, duration of sensory block, onset time for motor block, duration of motor block, time to achieve complete block etc were observed.

Results: Overall success rate was higher in USG guided group as compared to PNS guided group, which was statistically significant (p <0.05). Time to perform the block was significantly shorter in USG guided group (p <0.05). Onset time for sensory block, onset time for motor block & time to achieve a complete block was also shorter in USG guided group (p value <0.05). Duration of sensory & motor block was significantly prolonged in USG guided group (p <0.05)

Conclusion: Ultrasonography guided supraclavicular brachial plexus block is quick to perform, offers improved safety & accuracy in identifying the position of the nerves to be blocked & of the structures.