An evaluation of brachial plexus block using a nerve stimulator versus ultrasound guidance: A randomized controlled trial

Abstract

Background and Aims:This study was carried out to evaluate the difference in efficacy, safety, and complications of performing brachial plexus nerve blocks by using a nerve locator when compared to ultrasound (US) guidance.Material and Methods:A total of 102 patients undergoing upper limb surgery under supraclavicular brachial plexus blocks were randomly divided into two groups, one with US and the other with nerve stimulator (NS). In Group US, “Titan” Portable US Machine, Sonosite, Inc. Kensington, UK with a 9.0 MHz probe was used to visualize the brachial plexus and 40 ml of 0.25% bupivacaine solution was deposited around the brachial plexus in a graded manner. In Group (NS), the needle was inserted 1-1.5 cm above mid-point of clavicle. Once hand or wrist motion was detected at a current intensity of less than 0.4 mA 40 ml of 0.25% bupivacaine was administered. Onset of sensory and motor block of radial, ulnar and median nerves was recorded at 5-min intervals for 30-min. Block execution time, duration of block (time to first analgesic), inadvertent vascular puncture, and neurological complications were taken as the secondary outcome variables.Results:About 90% patients in US group and 73.1% in NS group, had successful blocks P = 0.028. The onset of block was faster in the Group US as compared to Group NS and this difference was significant (P 0.007) only in the radial nerve territory. The mean duration of the block was longer in Group US, 286.22 ± 42.339 compared to 204.37 ± 28.54-min in Group NS (P < 0.05). Accidental vascular punctures occurred in 7 patients in the NS group and only 1 patient in the US group.Conclusion:Ultrasound guidance for supraclavicular brachial plexus blockade provides a block that is faster in onset, has a better quality and lasts longer when compared with an equal dose delivered by conventional means.

Comparison of ultrasound with peripheral nerve stimulator guided technique for supraclavicular block in upper limb surgeries: A randomized controlled trial

“…In our study, the mean procedure time was significantly shorter in Group A than Group B (11.57 ± 2.75 min vs. 21.73 ± 4.835 min, respectively) similar to Singh et al ., who observed significantly shorter procedure time in USG group compared to PNS group during supraclavicular block (8.14 vs. 10.63 min, respectively). [ 8 ] Similarly, Williams et al . and Ratnawat et al .…”

“…have observed that out of 102 patients, 45 out of 50 (90%) patients had developed successful block with USG, compared to 38 of 52 (73.1%) in Group PNS requiring additional nerve blocks ( P = 0.028). [ 8 ] Duncan et al . and Williams et al .…”

The subcostal nerve as the target for nerve stimulator guided transverse abdominis plane blocks – A feasibility study

“…The failure rate is similar to or better than that of other PNS guided blocks. [1617] However, being a feasibility study, it may not be adequately powered to determine success and failure rates. Also, anatomically inaccurate blocks need not necessarily imply complete block failure,[5] as local anaesthetics diffuse through fascial planes and can result in partial blocks.…”

Intraoperative Nerve Stimulation During Brachial Plexus Surgery: Comparison Between a Totally Disposable Nerve Stimulator and Nerve Stimulator Normally Used for Nerve Blocks

“…1 Brachial plexus blocks and other nerve blocks are performed by anesthetists using a device that has 2 components: a nonsterile, battery-operated nerve stimulator which is connected to a sterile wire/needle. 2,3 For many years, our center has been using a totally disposable nerve stimulator during brachial plexus surgery. We have noted that the stimulator may fail to operate or operate intermittently during surgery, necessitating the use of more than 1 device in almost all cases.…”

“…Brachial plexus blocks and other nerve blocks are performed by anesthetists using a device that has 2 components: a non-sterile, battery-operated nerve stimulator which is connected to a sterile wire/needle. 2,3…”