A comparative clinical study of ultrasonography-guided perivascular and perineural axillary brachial plexus block for upper limb surgeries

Abstract

Background: Axillary brachial plexus block (ABPB) is safest among other methods of brachial plexus block because of its ease and reliability. The two approaches of ultrasonography-guided ABPB are perivascular (PV) and perineural (PN). Aims: This study was conducted to compare primary outcomes such as performance time, onset of the block, number of needle passes, block success rate, duration of sensory and motor block, and complications between ultrasound-guided PV and PN ABPB in patients posted for upper limb surgeries. Settings and Design: This prospective randomized study was conducted on 106 patients American Society of Anesthesiologists Class I and II posted for forearm, wrist, and hand surgeries, who were allotted into Group PV and Group PN 53 each. Materials and Methods: In both methods, 20 mL of the drug was used. To start with, musculocutaneous nerve was blocked with 5 mL of the drug. In the PV technique, remaining 15 mL of the drug was deposited anterior and posterior to axillary artery, and in PN technique, 5 mL of the drug was injected around radial, ulnar, and median nerve. Statistical Analysis: Mann–Whitney and Chi-square test were used for statistical analysis. Results: Significant difference was observed between the two groups in performance time (PV – 8.647 ± 0.54 min and PN – 14.53 ± 0.20 min), onset time (PV – 19.48 ± 2.83 min and PN – 13.86 ± 1.81 min), and number of needle passes (PV – 2.30 ± 0.50 and PN – 4.91 ± 0.66). Other parameters were comparable in both the groups. Conclusions: Ultrasound-guided PV axillary plexus block is better than PN axillary plexus block with respect to performance time and number of needle passes; but onset time was shorter in PN block, with precaution eliminating the risk of complications.

Comparison of perineural brachial plexus block and proximal perivascular block in ultrasound-guided axillary brachial plexus block

“…Tran et al [12] reported two, three, and four perivascular injection techniques, with procedure times of 574 ± 206, 603 ± 205 and 673 ± 218 s, respectively. Vastrad et al [2] used two separate doses on the 6-and 12-o'clock areas of the axillary artery and separated the MC nerve block, and their procedure time was 8.647 ± 0.5486 min. The more separated nerve block procedure will result in a longer procedure time and patient discomfort.…”

“…Brachial plexus block (BPB) constitutes a good option for forearm surgery because it decreases postoperative pain and enables early recovery and discharge after surgery [1]. The introduction of ultrasound has significantly improved the success rate and reduced the complications of BPB [2,3]. Ultrasonic guidance shows the anatomical structures in a targeted area and the route of the injection needle in real time [3,4].…”

“…Ultrasonic guidance shows the anatomical structures in a targeted area and the route of the injection needle in real time [3,4]. Various ultrasound injection techniques have been studied to increase the effectiveness of BPB [2,[5][6][7][8]. Ultrasound guidance not only facilitates the anesthetic procedure, but also decreases the dose of local anesthetics [9][10][11].…”

“…The PV approach involves locating the axillary artery and infiltrating the local anesthetics around the axillary artery. The PV approach proved effective in several studies that showed faster onset time with shorter procedure time, fewer needle passes, and less discomfort and pain associated with the procedure [2]. Both the PN and PV methods are needed to block the musculocutaneous (MC) nerve separately because the nerve is not in the vicinity of the artery.…”

Block Performance Indices of Perivascular and Perineural Techniques of Ultrasound-Guided Axillary Block in Upper Limb Surgeries

“…This was similar to results from studies by Vastrad et al . [ 20 ] and Kasat et al . [ 16 ] These differences in the imaging time, needling time, and subsequently total performance time were attributed to the difference in time needed for individual visualization and injection of LA around each of the axillary artery and the nerves in the PN group as relative to that required for just the musculocutaneous nerve and axillary artery in the PV group.…”