Single-point versus double-point injection technique of ultrasound-guided supraclavicular block: A randomized controlled study

Abstract

Background and Aims:This study aims to compare the single-point injection and double-point injection technique of ultrasound-guided supraclavicular block with regard to the success rate, time taken to perform the procedure, onset and duration of sensory and motor block, and complications.Material and Methods:A total of 60 American Society of Anesthesiologists physical status I and II patients between 20 and 50 years of age, with body mass index ≤30 kg/m2 posted for forearm surgeries, with anticipated surgical duration more than 1 h were randomly divided into two groups: group S (single-point injection) and group D (double-point injection technique). After locating the brachial plexus with ultrasound, needle was inserted from lateral to medial direction to reach the plexus. In group D, 20 ml of inj. bupivacaine 0.5% was deposited as 10 ml each in superior (in the cluster) and inferior pocket (corner pocket) between the plexus and subclavian artery with the help of hydrodissection while in group S the total 20 ml was deposited in the superior (in the cluster) pocket. The onset of sensory and motor block was assessed using pin prick method and modified Bromage scale. Adequacy of block was ensured by assessing the ulnar, radial, and median nerve distribution. Procedural time was defined from the point of scanning the plexus till the drug was injected completely. Total sensory, motor duration, and complications if any were noted.Results:Group D had higher success rate compared to group S (96.7 vs. 83.3%; P < 0.0001). The total procedural time was significantly more in group D compared to group S (14.6 ± 2.7 vs. 10.1 ± 1.7 min; P < 0.0001). The onset of sensory and motor block was faster and the duration of sensory and motor block was significantly longer in group D.Conclusion:The adequacy of block, sensory, and motor duration was significantly high in newer double-point injection technique. However, it requires longer procedural time compared to single-point injection technique.

New Simple Ultrasound‐Guided Transforaminal Injection in Patients With Radiculopathy in the Lower Cervical Spine

“…Advantages of musculoskeletal US include high resolution for the peripheral nerve, tendon, and muscle, high sensitivity for blood flow, and real‐time imaging of the needle tip and injection target, among others. More and more musculoskeletal procedures have been performed with US guidance, including joint injection, tendon sheath injection, bursa injection, and periperipheral nerve injection 9–12 . As for cervical transforaminal injection, most of the injections have been performed with fluoroscopy or CT guidance, whereas only a few studies have been found that uses US for guidance 13 .…”

Peripheral Nerve Injury After Upper-Extremity Surgery Performed Under Regional Anesthesia: A Systematic Review

“…A total of 53 articles were included in this systematic review: 38 hand studies and 15 shoulder studies ( Table S1 , available on the Journal’ s website at www.jhsgo.org ). 18 , 19 , 20 , 21 , 23 , 24 , 25 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 These 53 articles comprised 73 discrete, surgery-block combination study groups (54 hand and 19 shoulder groups) and 6,579 total subjects (2,875 hand and 3,704 shoulder subjects; Table 1 ). The large majority of studies in both groups were RCTs (94.4% hand and 78.9% shoulder RCTs); most were single-blind.…”

Intertruncal versus classical approach to the ultrasound-guided supraclavicular brachial plexus block for upper extremity surgery: study protocol for a randomized non-inferiority trial

“…However, the optimal needling technique for the SB is remaining controversial. Various studies have proposed a series of techniques of where to first inject the LA and how many injections to perform around the brachial plexus, which include single-, double-, triple-, targeted intracluster-, or modified-injection techniques for the last nearly two decades [ 3 – 6 , 9 , 11 , 16 ]. Up to now, the most common techniques for LA injection described at the first rib level are a single or double injection.…”