Ultrasound Guided Axillary Brachial Plexus Block Versus Supraclavicular Block In Emergency Crushed Hand Patients : A Comparative Study

Abstract

Background: The current study focusses on ultrasound guided Brachial Plexus Block (BPB) which plays an important role in patients with hand trauma either in pain control or for surgical intervention. The brachial plexus can be blocked by several techniques but the most commonly used are the Supraclavicular (SCB) and Axillary (AXB) blocks. Objective: To compare the two techniques with regards to the performance time, needling time, anesthesia-related time, block-related complications, number of needle pass and block related pain. Methods: After approval of the ethical committee and obtaining a written informed consent from patients, this prospective, randomized, interventional double-blinded study was done to patients undergoing emergency crushed hand surgery. 80 patients were allocated randomly into two equal groups. Under ultrasound guidance, the SCB and AXB were done for the two groups, respectively. The needling time, performance time, anesthesia-related time, onset time, number of 1st needle pass in each group and block related complications were noted. Statistical Analysis: Data were analysed using the Statistical Package for Social Science (IBM SPSS) version 23 SPSS. Results: Longer needling, performance, anesthesia-related time in the AXB group than SCB and less complications have occurred with AXB than SCB group. Conclusion: Axillary block of brachial plexus is a good alternative to Supraclavicular block in emergency crushed hand surgery and the choice is made according to the requirement of each case.

Axillary Brachial Plexus Block Compared with Other Regional Anesthesia Techniques in Distal Upper Limb Surgery: A Systematic Review and Meta-Analysis

“…LA medication and volumes are summarized in Appendix S5 . A short-acting LA was used in eleven studies (lidocaine [ 15 , 18 , 19 , 20 , 21 , 22 ], mepivacaine [ 1 , 23 , 24 , 25 , 26 ]), a long-acting LA in eleven studies (bupivacaine [ 16 , 27 , 28 , 29 , 30 ], ropivacaine [ 17 , 31 , 32 , 33 , 34 , 35 ]), and a mixture of short- and long-acting LA in six studies [ 36 , 37 , 38 , 39 , 40 , 41 ]. Volumes and dosage of LA of the ABPB varied widely, with the lowest being 20 mL and the highest being 60 mL.…”

“…Out of the 28 studies, 25 studies reported on surgical anesthesia [1,40]. Only 17 studies involving 1254 participants conducted an evaluation for adequate surgical anesthesia at an interval of 30 min after block completion [16,[18][19][20]22,23,25,27,28,30,31,[33][34][35][36][37]40].…”

“…Twenty-one studies looked at (some) side effects of block performance [1,[15][16][17][19][20][21][23][24][25][26][27][29][30][31][32][35][36][37]39,40].…”

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.…”

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

“…While comparing the methods for the ABPB, the success rate has been reported as the most important indicator, showing success rate 95%–100% with ultrasound introduction. [520] Therefore, different indicators are required in comparative studies; the block performance time and the onset time are important indicators apart from success rate. [21]…”