DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20182844

Evaluation of ultrasound guided verses nerve stimulator technique of interscalene brachial plexus block: insights from Indian multi-super specialty hospital

Kiran Kumar G. V., Rammohan Gurram, Gajanan Fultambkar, Amit Omprakash Gupta, Onkar C. Swami

Abstract


Background: To provide adequate intraoperative anaesthesia and postoperative analgesia for orthopaedic surgery continues to be a procedural challenge. The administration of brachial plexus anaesthesia can be facilitated through nerve stimulation or by ultrasound guidance. Hence study was conducted to compare differences in these techniques in patients undergoing interscalene brachial plexus block (ISSB).

Methods: In this prospective, randomized, observer-blinded study, 60 patients (Male=41, Female=19) were scheduled for orthopaedic shoulder and upper arm surgeries matching inclusion and exclusion criteria. Patients were randomly allocated to either Ultrasound (US, n=30) group or Nerve Stimulator (NS, n=30) group through a computer-generated randomization.

Results: There was significant difference between US and NS group with respect to average number of attempts taken, block performance time (BPT), onset of sensory and motor block, duration of motor block and patient satisfaction score. Whereas not much significant difference was observed in duration of sensory block, block success rate and incidence of post operative side effects.

Conclusions: The results suggest that US guided ISBB is significantly superior to NS guided block in terms of faster onset of action; lower number of attempts to locate Interscalene brachial plexus; longer duration of block and overall success rate with favourable tolerability at real-life scenario.


Keywords


Interscalene brachial plexus block, Nerve stimulator equipment, Regional anaesthetic technique, Ropivacaine, Ultrasound equipment

Full Text:

PDF

References


Tsui B. Ultrasound-guidance and nerve stimulation: implication for the future practice of regional anesthesia. Can J Anesth. 2007;54:165-70.

Roberta H, Marschall K. Stoelting's Anesthesia and Co-Existing Disease. china: Elsevier Inc; 2012:460-461.

Bishop JY, Sprague M, Gelber J, Krol M, Rosenblatt MA, Gladstone JN, et al. Interscalene regional anesthesia for arthroscopic shoulder surgery: a safe and effective technique. Journal of shoulder and elbow surgery. 2006 Sep 1;15(5):567-70.

Bishop JY, Sprague M, Gelber J, Krol M, Rosenblatt MA, Gladstone J, Flatow EL. Interscalene regional anesthesia for shoulder surgery. JBJS. 2005 May 1;87(5):974-9.

Ilfeld BM, Morey TE, Wright TW, Chidgey LK, Enneking FK. Continuous Interscalene brachial plexus block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesth Analg. 2003;96:1089-95.

Pither C, Raj PP, Ford DJ. The use of peripheral nerve stimulators for regional anesthesia: a review of experimental characteristics, technique, and clinical applications. Reg Anesth Pain Med. 1985;10(2):49-58.

Fanelli G, Casati A, Garancini P, Torri G. Nerve stimulator and multiple injection technique for upper and lower limb blockade: failure rate, patient acceptance, and neurologic complications: Study Group on Regional Anesthesia. Anesth Analg. 1999;88(4):847-52.

Franco CD, Viera ZE. 1001 subclavian perivascular brachial plexus blocks: success with a nerve stimulator. Reg Anesth Pain Med. 2000;25:41-6.

Brull R, McCartney CJL, Sawyer RJ, Von SH. The indications and applications of interscalene brachial plexus block for surgery about the shoulder. Acute Pain. 2004;6:57-77.

Tsai TP, Vuckovic I, Dilberovic F, Obhodzas M, Kapur E, Divanovic KA, et al. Intensity of the stimulating current may not be a reliable indicator of intraneural needle placement. Reg Anesth Pain Med. 2008;33:207-10.

Sinha SK, Abrams JH, Weller RS. Ultrasound-guided interscalene needle placement produces successful anesthesia regardless of motor stimulation above or below 0.5 mA. Anesth Analg. 2007;105:848-52.

Chan VW, Brull R, McCartney CJ, Xu D, Abbas S, Shannon P. An ultrasonographic and histological study of intraneural injection and electrical stimulation in pigs. Anesth Analg. 2007;104:1281-4.

Liu SS, Zayas VM, Gordon MA, Beathe JC, Maalouf DB, Paroli L, et al. A prospective, randomized, controlled trial comparing ultrasound versus nerve stimulator guidance for interscalene block for ambulatory shoulder surgery for postoperative neurological symptoms. Anesthesia & Analgesia. 2009 Jul 1;109(1):265-71.

Marhofer P, Chan VW. Ultrasound-guided regional anesthesia: current concepts and future trends. Anesth Analg. 2007;104:1265-9.

Falcão LF, Perez MV, de Castro I, Yamashita AM, Tardelli MA, Amaral JL. Minimum effective volume of 0.5% bupivacaine with epinephrine in ultrasound-guided interscalene brachial plexus block. Br J Anaesth. 2013;110(3):450-5.

Hopkins PM. Ultrasound guidance as a gold standard in regional anaesthesia. Br J Anaesth. 2007;98(3):299-301.

Fredrickson MJ, Ball CM, Dalgleish AJ. A prospective randomized comparison of ultrasound guidance versus neurostimulation for interscalene catheter placement. Reg Anesth Pain Med. 2009;34(6):590-4.

McCartney CJ, Lin L, Shastri U. Evidence basis for the use of ultrasound for upper-extremity blocks. Reg Anesth Pain Med. 2010;35(2):10-5.

Kapral S, Greher M, Huber G, Willschke H, Kettner S, Kdolsky R, et al. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med. 2008;33(3):253-8.

Liu SS, Ngeow J, Yadeau JT. Ultrasound guided regional anesthesia and analgesia: a qualitative systematic review. Reg Anesth Pain Med. 2009;34:47-59.

Moore DD, Maerz T, Anderson K. Shoulder surgeons’ perceptions of interscalene nerve blocks and a review of complications rates in the literature. Phys Sports Med. 2013;41(3):77-84.

Rodgers A, Walker N, Chug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomized trials. BMJ. 2000;321:1493.

Beattie WS, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction; a meta-analyses. Anesth Analg. 2001;93:835-58.

Buist RJ. A survey of the practice of regional anaesthesia. J R Soc Med. 1990;83:709-12.

McCartney CJ, Brull R, Chan VW, Katz J, Abbas S, Graham B, et al. Early but no long term benefit of regional compared with general anaesthesia for ambulatory hand surgery. Anesthesiology. 2004;101:461-7.

Gonano C, Kettner SC, Ernstbrunner M, Schebesta K, Chiari A, Marhofer P. Comparison of economical aspects of interscalene brachial plexus blockade and general anaesthesia for arthroscopic shoulder surgery. Br J Anaesth. 2009;103(3):428-33.

Aromaa U, Lahdensuu M, Cozanitis DA. Severe complications associated with epidural and spinal anaesthesia in Finland 1987-1993. A study based on patient insurance claims. Acta Anaesthesiol Scand. 1997;41:445-52.

Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuroaxial blockades in Sweden 1990-1999. Anesthesiology. 2004;101:950-9.

Klein SM, Greengrass RA, Steele SM, D'ercole FJ, Speer KP, Gleason DH, et al. A comparison of 0.5% bupivacaine, 0.5% ropivacaine, and 0.75% ropivacaine for interscalene brachial plexus block. Anesth Analg. 1998;87:1316-9.

Vaghadia H, Chan V, Ganapathy S, Lui A, McKenna J, Zimmer K. A multicentre trial of Ropivacaine 7.5mg/ml V/s Bupivacaine 5mg/ml for supraclavicular brachial plexus anaesthesia. Can J Anaesth. 1999;46(10):946-51.

Pablo EH, Diogo BC, Getúlio RF, Ultrasound-Guided Nerve Blocks. Rev Bras Anestesiol. 2007;57:1:106-23.