Comparison Of Magnesium Sulphate With Dexamethasone As Adjuvant To Local Anaesthetics For Supraclavicular Brachial Plexus Block

Background:Background and objectives: Brachial plexus block is routinely performed method of regional nerve block. Different adjuvantshave been used to hasten the onset and prolong the duration of peripheral nerve blocks. In this study we compared dexamethasone and magnesium sulphate as an adjuvant to combination of bupivacaine and lignocaine in supraclavicular brachial plexus block with regards to comparison of time required for onset and duration of sensory and motor block, duration of post-operative analgesia and requirement of rescue analgesics in first 24 hours postoperatively. Material And Methods:This prospective, observational, comparative study was performed on 60 patients of ASA class I, II and III in the age group of 18 to 70 years, weighing 40 to 70 kilogram and undergoing lower arm, elbow, forearm and hand surgeriesdivided in to 2 equal groups D and M. Group D received dexamethasone 8mg and group M received magnesium sulphate 500mg along with bupivacaine(0.5%) and lignocaine(2%).Result:Onest of sensory and motor blockade was significantly faster in group D compared to group M (p-0.001, p<0.001 respectively). Duration of sensory and motor blockade and duration of postoperative analgesia was prolonged in group D compared to group M (p-0.008, p-0.034).Conclusion:Addition of dexamethasone or magnesium sulphate as adjuvant in supraclavicular block prolongs postoperative analgesia. Dexamethasone provided quicker onset and longer duration of analgesia with lesser consumption of rescue analgesic in comparison to magnesium sulphate.

Comparison Between Dexamethasone and Fentanyl as an Adjuvant to Bupivacaine and Lignocaine in Supraclavicular Brachial Plexus Block for Upper Limb Surgery

Objective: To compare the effects of dexamethasone and fentanyl when added to a mixture of bupivacaine and lignocaine in supraclavicular blocks in patients undergoing forearm surgeries. Methods: Sixty-six patients aged between 20 to 60 years old belonging to ASA one or two were recruited prospectively, double-blinded, and randomized way. Supraclavicular block under sonographic guidance was performed in the three groups by using injection bupivacaine (0.5%) 20 cc + injection lignocaine (2%) 10 cc + injection 0.9% normal saline; 2ml (Group S), injection bupivacaine (0.5%) 20 cc + injection lignocaine (2%) 10 cc + injection dexamethasone 8 mg (Group D), and injection bupivacaine (0.5%) 20 cc + injection lignocaine (2%) 10 cc + injection fentanyl 50 µgm (Group F). The onset time of sensory and motor block, duration of sensory and motor block, and hemodynamic variables were recorded. Results: Group D showed a significantly greater sensory and motor block duration than other groups (P = 0.001). Comparison of hemodynamic variables failed to reveal any statistically significant differences between all the groups. Conclusion: Both dexamethasone and fentanyl are good adjuvants in the supraclavicular block, but dexamethasone is better, given faster onset and duration of analgesia.

Comparison between Supraclavicular and Infraclavicular Brachial Plexus Block in Patients Undergoing Forearm Surgeries.

Of the various modalities of achieving surgical anaesthesia of the forearm, brachialplexus block by injecting local anaesthetic is considered highly beneficial andpractical. Supraclavicular and infra-clavicular approaches of brachial plexus blocksprovide comprehensive anaesthesia for surgeries of the forearm. The primaryoutcome measured was the comparison of two blocks with respect to sparing of anydermatome, whereas the secondary outcomes measured were block performancetime, duration of analgesia, and complications associated with each technique.METHODSSixty adult patients of either sex belonging to the American Society ofAnesthesiologists (ASA) physical status I and II in the age range of 20–70 yearsscheduled to undergo surgeries of the forearm were divided into two groups:Supraclavicular (SCB group) and Infraclavicular (ICB group) of 30 each. Both theblocks were given by 30 mL of 0.375% injection Bupivacaine using a 22G, 5 cminsulated needle and nerve locator. Both the groups were compared with respect tosparing of dermatomes, block performance time, duration of analgesia andcomplications like Horner’s syndrome, vascular puncture, and pneumothorax.Statistical analysis was performed with Student unpaired t‑test and Chi‑square testand p < 0.05 was considered to be statistically significant.RESULTSBlock performance time was similar in both the groups. Duration of analgesia wascomparable among the two groups. The incidence of incomplete radial block wassignificantly higher in ICB group as compared to SCB group (p= 0.046, S). Incidenceof Horner’s syndrome in SCB group were higher than in ICB group, but they werestatistically insignificant. (p=0.15, NS). One patient in SCB group had subclavian veinpuncture as compared to none in ICB group and was statistically insignificant.CONCLUSIONSSupraclavicular approach for brachial plexus block provides reliable andcomprehensive anaesthesia for forearm surgeries without any significantdermatomal sparing unlike infraclavicular approach. Both groups had similar blockperformance time and duration of analgesia for forearm surgeries. Even though SCBwas associated with complications like Horner’s syndrome and vascular puncture, itwas transient and statistically insignificant. Hence supraclavicular approach isconsidered to be superior to infraclavicular approach.

A comparative study on the effectiveness of bupivacaine and ropivacaine for supraclavicular block

Background: Bupivacaine and Ropivacaine have been extensively studied &their properties with respect to onset, duration and quality of block. This study aims to detect whether addition of clonidine to both of them changes their properties. This study also aims to use lower than usual dosages for both the local anesthetics to prevent adverse effects of local anesthetics.Methods: After obtaining ethical approval, the study was carried out on patients undergoing elective upper limb surgeries. They were randomly divided into two Groups: Group B and Group R. The onset and duration of sensory and motor blockade and other parameters were assessed.Results: The onset of blockade, both sensory & motor was earlier in Ropivacaine as compared to Bupivacaine group. Mean duration of blockade, both sensory & motor, was more in the Bupivacaine group.  Conclusions: Addition of Clonidine enabled the use of low concentrations (0.25%) of both the anesthetics. Also, Ropivacaine (0.25%) has faster onset of sensory and motor blockade, shorter duration of action and less motor blockade compared to Bupivacaine.

A Comparative Study on the Quality of Blockade by Bupivacaine and Ropivacaine for Supraclavicular Block

Introduction: Bupivacaine and Ropivacaine are the two mostfrequently used local anesthetics for brachial plexus blocks.There are many studies comparing the onset, duration andrecovery of the patient after the anesthesia, but not manyof these studies focus on the quality of anesthesia in termsof requirement of additional anesthesia intraoperatively.Therefore, this study aimed to assess the quality of anesthesiaprovided by the reduced concentration of both the anestheticagents.Material and Method: The study was carried out on patientsin the age group of 18 to 60 years with ASA grade I and II,undergoing elective operative procedures for upper limbsurgeries (i.e. elbow, forearm and hand surgeries). They wererandomly divided in Group I (Bupivacaine) and Group II(Ropivacaine). The quality of anesthesia was assessed.Results: While only 9 patients in Group II required additionalanesthesia (1 case: general anesthesia), 20 patients in GroupI required additional anesthesia (5 cases: general anesthesia).Rest all the parameters were comparable.Conclusion: Both the drugs provided effective anesthesia inlow concentrations. However, the quality of anesthesia wasbetter with Ropivacaine compared to Bupivacaine.

Comparative Evaluation of Dexmedetomedine versus Clonidine as an Adjuvant in Supraclavicular Brachial Plexus Block.

Background: Supraclavicular block is considered to be the ideal block for upper extremity surgeries as it provides ideal operative conditions by complete muscle relaxation and stable intra operative hemodynamics. Aim and Objectives: The aim of the study was to evaluate the efficacy and safety of Clonidine and Dexmedetomedine as an adjuvant to Ropivacaine in supraclavicular brachial plexus block. Material and Methods: Ninety patients were divided randomly into 3 groups of 30 each. Group CL: Patients received injection Ropivacaine 0.5% (30 ml) + normal saline (1 ml), Group CD: Patients received injection Ropivacaine 0.5% (30 ml) + injection Clonidine (150 μg), Group DX: Patients received injection Ropivacaine 0.5% (30 ml) + injection Dexmedetomidine (100 μg). Onset of sensory and motor block, duration of analgesia and motor block, complications and side effects of the study drugs were compared among the three groups. Results: The onset of sensory and motor block was earliest in Group DX, followed by Group CD, f llowed by Group CL. Complete sensory and motor block were earliest in Group DX, followed by Group CD, followed by Group CL. Similarly duration of sensory and motor block was maximum in Group DX, followed by Group CD, followed by Group CL (p<0.05). Conclusion: Dexmedetomedine and Clonidine when added to Ropivacaine for supraclavicular brachial plexus block prolong the duration of analgesia. But Dexmedetomedine is a better adjuvant as compared to Clonidine

Ultrasound Guided Supraclavicular Block: A Comparison between Levobupivacaine with Dexamethasone and Levobupivacaine Alone

Dexamethasone as an adjuvant to bupivacaine for supraclavicular brachial plexus block prolongs motor and sensory blockade. However, the effect of dexamethasone when added to levobupivacaine has not been well studied. This study was conducted to find out analgesic efficacy of dexamethasone as adjuvant to levobupivacaine in supraclavicular brachial plexus block. Methods: Ultrasound guided SCBP block was given to sixty patients, randomly assigned into two groups. Group S (thirty patients) received 2 mL normal saline with 25 mL levobupivacaine (0.5%) and Group D (thirty patients) received 2 mL of dexamethasone (8 mg) with 25 mL of levobupivacaine (0.5%), respectively. Time for the first rescue analgesia, number of rescue analgesics required in 24 h and different block characteristics was assessed. Chi square test and Student’s t test were used for statistical analysis. Results: Time for request of the first rescue analgesia was 396.13 ± 109.42 min in Group S and 705.80 ± 121.46 min in Group D (P < 0.001). The requirement for rescue analgesics was more in Group S when compared to Group D. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S. Conclusions: The addition of dexamethasone to levobupivacaine in SCBP blockade prolonged time for first rescue analgesia and reduced the requirement of rescue analgesics with faster onset and prolonged duration of sensory and motor block.

A randomised prospective comparative study of evaluation of dexmedetomidine an adjuvant to ropivacaine for ultrasound guided supraclavicular block

Background:There are clinical evidences for efficacy of dexmedetomidine as an adjuvant to local anaesthetic for peripheral nerve block, but very few published study are available on continuation of dexmedetomidine, with ropivacaine for ultrasound guided supraclavicular block. The present study has been designed to elucidate the effect of dexmedetomidine, in combination ropivacaine on various parameters.Methods:During period of 2 year and 3 months 84 patients were enrolled for thisstudy. Patient in Group A were received 15 ml of 0.5% ropivacaine with 100 microgram one ml dexmedetomidine and Group B were received 15ml of 0.5% of ropivacaine with 1 ml of normal saline. Drug solution was prepared by same individual and was not part ofstudy.Results:Both the group were comparable to each other regarding demography profile. The duration of sensory block 644.96±72.4 min in group A and the duration of sensory block in Group B was 731.53±131.54 min with p value0.00354.The duration of motor block was 661.5±29.25 in group A and 559.77±29.25 in Group B with P value 0.0001. Duration of analgesia in Group A was 457.06±34.47 min and it was 345.70±38.032min in Group B.The supplementation of intravenous opioid was required in 3 patients in Group A and 10 patients in group B with P value 0.037. Conclusions: When 100 microgram of dexmedetomidine was added as an adjuvant to ropivacaineis associated with early onset of sensory and motor block, prolongation of sensory and motor block and duration of analgesia in comparison with ropivacaine alone

Brachial Plexus Bock With Bupivacaine: Effects Of Added Alpha Adrenergic Agonist Clonidine & Comparison With Epinephrine. A Randomised Control Study

Supraclavicular brachial plexus block is one of the most commonly employed regional anesthesia technique & is often described as “Spinal anesthesia of Upper limb”. Bupivacaine is one of the commonly used local anesthetic used for plexus anesthesia as it has long duration of action, however many additives have been tried in various studies in the search to decrease the latency of its onset of neural blockade as well as to increase its duration of analgesia, thereby improving the efficacy of peripheral neural blocks. We therefore studied the effect of clonidine 150 micrograms when added as an adjunct to bupivacaine for supraclavicular brachial plexus block in comparison with Bupivacaine combined with Epinephrine and Bupivacaine alone, in a rural tertiary care medical institute. We found that addition of clonidine provides rapid onset of anesthesia along with prolonged sensory, motor blockade and prolonged duration of analgesia without any significant side effects as compared to 2.025% bupivacaine with epinephrine or 0.25% Bupivacaine alone.

A Comparative Prospective Randomized Clinical Study Between Supraclavicular Perivascular Technique And Infraclavicular Brachial Plexus Blockade For Below Elbow Surgeries

OBJECTIVE: To compare the efficacy of supraclavicular perivascular technique and vertical infraclavicular achial plexus block, using nerve locator for below elbow surgeries. MATERIALS AND METHODS: Eighty patients of ASA grade I or II of either sex undergoing below elbow surgeries (mostly orthopedic surgeries) were randomly allocated into group S and group I. Each group comprises of 40 patients. Surgery was done under Vertical Infraclavicular approach of Brachial plexus Block in Group I Supraclavicular perivascular approach of Brachial plexus block in GroupS. RESULTS: The supraclavicular perivascular technique and vertical infraclavicular achial plexus block, using nerve locator for below elbow surgeries to evaluate the Ease of technique ,Time taken for the onset of sensory and motor blockade ,Total duration of sensory and motor blockade and Occurrence of complications statistically showed no significant differences between the two groups. CONCLUSION: Nerve locator guided Infraclavicular block of achial plexus is similar to nerve locator guided supraclavicular block in the form of ease of technique, onset and duration of sensory & motor blockade and on complication rate.

Unilateral Horner's Syndrome following supraclavicular brachial plexus block / 고신대학교의과대학학술지

Supraclavicular brachial plexus block, due to its wide range of indications, is the most widely practiced procedure in anesthesiology. We experienced the case of a 45-year-old female patient who developed unilateral Horner's Syndrome after the use of supraclavicular brachial plexus block. The patient recovered spontaneously from the Horner's syndrome after 2 hours. If Horner's syndrome should occur, its etiology will need to be assessed. It is also important to assure the patient they will recover from the complication within a year.

To Compare the Effect of Dexmedetomidine and Clonidine as Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block for Upper Limb Surgery

Background and Aim: Alpha-2 agonists as adjuvant to local anaesthetic agents for PNB enhance the quality and duration of analgesia. Aim of this prospective, double blind, randomised placebo controlled study was to compare the affect addition of Dexmedetomidine and clonidine to Ropivacaine with respect to onset, peak, and duration of sensory-motor block and duration of analgesia in Supraclavicular brachial plexus block. Materials and methods: Ninety ASA grade I or II patients of either sex, aged 18-60 years age scheduled for elective upper limb surgery were equally divided in three groups (n=30).Group R received 0.75% Ropivacaine 30 ml + 1ml NS, Group RC received 0.75% Ropivacaine 30ml +1µgm/kg of clonidine, Group RD received 0.75% Ropivacaine 30ml + 1µgm/kg of Dexmedetomidine in Supraclavicular plexus block by using nerve locator. Ashish Kumar Narolia, Kanta Bhati, Kuldeep Saini, Anita Pareek, Meera Kumari. To Compare the Effect of Dexmedetomidine and Clonidine as Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block for Upper Limb Surgery. IAIM, 2017; 4(9): 82-90. Page 83 Results: Onset (sensory=7.6± 1.56, 6.13± 1.59, 4.13±1.35, in motor 10.23± 1.79, 9.03± 2.31, 6.50± 1.57 respectively), peak(sensory 17.33±2.89, 13.66±3.16, 10.63 ±2.89, in motor 21.76±2.56, 18.46±3.0, 15.66±3.20 respectively) and duration(sensory 239.83±39.96, 322.0±58.21, 375.0±53.69, in motor 206.0±40.71, 285.0±56.30, 332.50±57.84 respectively) of sensorimotor block and duration of analgesia (279.0±43.67, 357.16±55.85, 412.16±50.06 respectively)were prolonged in Dexmedetomidine group as compared to other both group. VAS and sedation score was better in dexmedetomidine group than clonidine group. Hemodynamic stability was comparable in all three groups and no complications were seen in any of the group. Conclusion: Dexmedetomidine (1µg/kg) is better than clonidine as adjuvant to 0.75% Ropivacaine in supraclavicular brachial plexus block for upper limb surgeries.

Efficiency of levobupivacaine and bupivacaine for supraclavicular block: a randomized double-blind comparative study / Eficiência de levobupivacaína e bupivacaína para bloqueio supraclavicular: estudo comparativo, duplo-cego e randomizado / Eficiencia de la levobupivacaína y la bupivacaína para el bloqueo supraclavicular: estudio comparativo, doble ciego y aleatorizado

Background and objectives: Success rate of catheter applications is low in supraclavicular block. Thus, bupivacaine and levobupivacaine become important with their long effect time in single injection practices. In this study, we aimed to compare the effectiveness, side effects and complications of bupivacaine and levobupivacaine in supraclavicular block. Methods: Sixty patients aged between 20 and 65, with body weight between 50 and 100 kg, in the ASA I-II-III group who were scheduled for hand, forearm and arm surgery using supraclavicular block were randomized into two groups of 30. The patients received 30 ml 0.5% bupivacaine (Group B) or 30 ml 0.5% levobupivacaine (Group L). Motor and sensory blocks were evaluated. Motor and sensory block onset times, total block durations, postoperative pain, amount of postoperative analgesic used and patient satisfaction were recorded. Results: Demographic data, distribution of surgical area and hemodynamic data were similar between the two groups. Surgery, motor and sensory block durations of Group B and L patients did not vary statistically significantly. However, motor and sensory block onset times in Group B were significantly shorter than Group L (p < 0.05). The mean time for first postoperative analgesic demand were 16.6 ± 8.0 h in Group B and 14.4 ± 7.3 h in Group L (p > 0.05). Conclusion: 30 ml 0.5% bupivacaine and levobupivacaine provide similar block characteristics for supraclavicular block. Bupivacaine leads to faster motor and sensory block onset compared to levobupivacaine however similar duration of postoperative analgesia. .

Justificativa e objetivos: a taxa de sucesso de aplicações de cateter é baixa em bloqueio supraclavicular. Assim, bupivacaína e levobupivacaína tornaram-se importantes por causa do efeito de longa duração em práticas de injeção única. Neste estudo, o objetivo foi comparar a eficácia, os efeitos colaterais e as complicações de bupivacaína e levobupivacaína em bloqueio supraclavicular. Métodos: foram randomizados em grupos de 30 cada 60 pacientes, entre 20-65 anos, 50-100 kg, estado físico ASA I-II-III, programados para cirurgia de mão, antebraço e braço com bloqueio supraclavicular. Receberam 30 mL de bupivacaína a 0,5% (Grupo B) ou 30 mL de levobupivacaína a 0,5% (Grupo L). Os bloqueios sensorial e motor foram avaliados e o tempo de início dos bloqueios, a duração dos bloqueios, a dor pós-operatória, a quantidade de analgesia pós-operatória e a satisfação dos pacientes foram registrados. Resultados: os dados demográficos, a distribuição da área cirúrgica e os dados hemodinâmicos foram semelhantes entre os dois grupos. A duração da cirurgia e dos bloqueios sensorial e motor não foi estatisticamente diferente entre os grupos B e L. Contudo, os tempos de início dos bloqueios sensorial e motor do Grupo B foram significativamente menores do que os do Grupo L (p < 0,05). O tempo médio para a primeira solicitação de analgésico no pós-operatório foi de 16,6 ± 8 horas no grupo B e 14,4 ± 7,3 horas no Grupo L (p > 0,05). Conclusão: características semelhantes para o bloqueio supraclavicular são fornecidas por 30 mL de bupivacaína a 0,5% e levobupivacaína. Bupivacaína proporciona início mais rápido de bloqueio sensorial e motor em comparação ...

Justificación y objetivos: la tasa de éxito de las aplicaciones de catéter es baja en el bloqueo supraclavicular. Así, la bupivacaína y la levobupivacaína son importantes debido al efecto a largo plazo en las prácticas de inyección única. En este estudio, el objetivo fue comparar la eficacia, los efectos colaterales y las complicaciones de la bupivacaína y la levobupivacaína en el bloqueo supraclavicular. Métodos: sesenta pacientes, con edades entre 20-65 años, 50-100 kg, estado físico ASA I-II-III, programados para cirugía de mano, antebrazo y brazo con bloqueo supraclavicular, fueron aleatorizados en grupos de 30 pacientes cada uno. Los pacientes recibieron 30 mL de bupivacaína al 0,5% (grupo B) o 30 mL de levobupivacaína al 0,5% (grupo L). Se evaluaron los bloqueos sensorial y motor y se registraron los tiempos de inicio de los bloqueos, duración de los bloqueos, dolor postoperatorio, cantidad de analgesia postoperatoria y satisfacción de los pacientes. Resultados: los datos demográficos, la distribución del área quirúrgica y los datos hemodinámicos fueron similares en los 2 grupos. La duración de la cirugía y de los bloqueos sensorial y motor no fue estadísticamente diferente entre los grupos B y L. Sin embargo, los tiempos de inicio de los bloqueos sensorial y motor del grupo B fueron significativamente menores que los del grupo L (p < 0,05). El tiempo promedio para la primera solicitación de analgésico en el postoperatorio fue de 16,6 ± 8,0 h en el grupo B y 14,4 ± 7,3 h en el grupo L (p > 0,05). Conclusión: los 30 mL de bupivacaína al 0,5% y levobupivacaína suministran características de bloqueo similares para el bloqueo supraclavicular. La bupivacaína proporciona un inicio más rápido de bloqueo sensorial y motor en comparación ...

Minimum effective volume of mepivacaine for ultrasound-guided supraclavicular block / 대한마취과학회지

BACKGROUND: The aim of this study was to estimate the minimum effective volume (MEV) of 1.5% mepivacaine for ultrasound-guided supraclavicular block by placing the needle near the lower trunk of brachial plexus and multiple injections. METHODS: Thirty patients undergoing forearm and hand surgery received ultrasound-guided supraclavicular block with 1.5% mepivacaine. The initial volume of local anesthetic injected was 24 ml, and local anesthetic volume for the next patient was determined by the response of the previous patient. The next patient received a 3 ml higher volume in the case of the failure of the previous case. If the previous block was successful, the next volume was 3 ml lower. MEV was estimated by the Dixon and Massey up and down method. MEV in 95, 90, and 50% of patients (MEV95, MEV90, and MEV50) were calculated using probit transformation and logistic regression. RESULTS: MEV95 of 1.5% mepivacaine was 17 ml (95% confidence interval [CI], 13-42 ml), MEV90 was 15 ml (95% CI, 12-34 ml), and MEV50 was 9 ml (95% CI, 4-12 ml). Twelve patients had a failed block. Three patients received general anesthesia. Nine patients could undergo surgery with sedation only. Only one patient showed hemi-diaphragmatic paresis. CONCLUSIONS: MEV95 was 17 ml, MEV90 was 15 ml, and MEV50 was 9 ml. However, needle location near the lower trunk of brachial plexus and multiple injections should be performed.

Comparison of ultrasound-guided supraclavicular block according to the various volumes of local anesthetic / 대한마취과학회지

BACKGROUND: The ultrasound guidance in regional nerve blocks has recently been introduced and gaining popularity. Ultrasound-guided supraclavicular block has many advantages including the higher success rate, faster onset time, and fewer complications. The aim of this study was to examine the clinical data according to the varied volume of local anesthetics in the ultrasound-guided supraclavicular block. METHODS: One hundred twenty patients were randomized into four groups, according to the local anesthetic volume used: Group 35 (n = 30), Group 30 (n = 30), Group 25 (n = 30), and Group 20 (n = 30). Supraclavicular blocks were performed with 1% mepivacaine 35 ml, 30 ml, 25 ml, and 20 ml, respectively. The success rate, onset time, and complications were checked and evaluated. RESULTS: The success rate (66.7%) was lower in Group 20 than that of Group 35 (96.7%) (P < 0.05). The average onset times of Group 35, Group 30, Group 25, and Group 20 were 14.3 +/- 6.9 min, 13.6 +/- 4.5 min, 16.7 +/- 4.6 min, and 16.5 +/- 3.7 min, respectively. There were no significant differences. Horner's syndrome was higher in Group 35 (P < 0.05). CONCLUSIONS: In conclusion, we achieved 90% success rate with 30 ml of 1% mepivacaine. Therefore, we suggest 30 ml of local anesthetic volume for ultrasound-guided supraclavicular block.

Comparison of a supraclavicular block showing upper arm twitching response with a supraclavicular block showing wrist or finger twitching response / 대한마취과학회지

BACKGROUND: Although an ultrasound-guided brachial plexus block has become the standard, conventional brachial plexus blocks with a paresthesia or muscle twitch are still performed. However despite eliciting a paresthesia or muscle twitch, there are some cases in whom the brachial plexus block fails. This has been attributed to the difference between the proximal response (PR) and distal response (DR). Therefore, this study compared a supraclavicular block showing a PR with that showing a DR. In addition, clinical data such as success rate, onset time, and complications were examined. METHODS: Eighty three patients received a supraclavicular block with a nerve stimulator. All blocks were performed with 1% mepivacaine 40 ml. The subjects were divided into two groups-Group PR (n = 20, contraction of triceps or biceps) and Group DR (n = 63, flexion or extension of wrist or fingers) according to the types of muscle twitch. The success rate, onset time, and complications were measured and evaluated. RESULTS: The success rate of Group DR (93.7%) was higher than that of Group PR (75.0%) (P < 0.05). The onset times of Group PR and DR were 15.3 +/- 6.7 min and 14.4 +/- 6.0 min, respectively. CONCLUSIONS: The elicitation of a DR was more effective in increasing the success rate and reducing the onset time than the elicitation of a PR in a single-injection supraclavicular block.

Cases series: ultrasound-guided supraclavicular block in 105 patients / 대한마취과학회지

BACKGROUND: Multiple needle attempts to gain a muscle twitch or a paresthesia for a classical supraclavicular brachial plexus block can increase the risks of nerve damage or pain. The aims of this study were to obtain reliable clinical data on ultrasound-guided supraclavicular blocks, demonstrate the higher success rate and fewer complications, and design an injection method for patients whose brachial plexus can not be located. METHODS: 105 patients received an ultrasound-guided supraclavicular block. 40 ml of 1% mepivacaine was injected without a muscle twitch or paresthesia. The groups were divided into two groups - Group A (n = 92, patients who had visible brachial plexus) and Group B (n = 13, patients whose brachial plexus can't be located). After the blocks, the clinical characteristics such as the success rate, the time to onset, the extent of the sensory block, and occurrence of complications were evaluated. RESULTS: The Success rate of Group A (98.9%) was higher than that of Group B (84.6%) (P < 0.05). The overall success rate was 97.1%. All patients could be operated on under sedation. The time to onset of Group A (12.6 +/- 4.4 min) was shorter than that in Group B (23.1 +/- 5.1 min) (P < 0.05). The overall time to onset was 13.8 +/- 5.5 min. There were no serious complications such as pneumothorax. CONCLUSIONS: An ultrasound-guided supraclavicular block is very effective in even patients whose brachial plexus can not be located.

Dyspnea after supraclavicular brachial plexus block in a morbidly obese patient due to phrenic nerve block: A case report / 대한마취과학회지

A 57-year-old woman with morbid obesity (BMI: 37.39) was scheduled for ligament reconstruction with tendon interposition of the carpometacarpal joint. A difficult supraclavicular brachial plexus block was performed using a 22-gauge regional block needle with a nerve stimulator and 40 ml of 1% mepivacaine. Approximately 10 minutes after the injection, she complained dyspnea, shortness of breath and right mid-thoracic pain. Her oxygen saturation decreased from 100% to 95%. Diagnostic workup revealed right diaphragmatic elevation caused by phrenic nerve block. General anesthesia was induced because of the unsuccessful brachial plexus block and dyspnea with chest pain. She recovered without any residual complications and was discharged on the third postoperative day. Phrenic nerve block is a common complication in supraclavicular brachial plexus block but it is usually not severe and reassurance is enough to control it. However, pre-operative physical conditions that may lead to decreased respiratory reserves, such as morbid obesity should be considered as a risk factors when conducting supraclavicular brachial plexus block.

Lower interscalene approach, the novel landmark for more success rate of supraclavicular block: a comparison with the classical approach in fresh cadavers.

Objective: To create a novel landmark for supraclavicular block, the lower interscalene approach, to increase its success rate. Methods: A prospective study was performed and carried out at the Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University. Both the lower interscalene approach and the classical approach were tested by simulating the supraclavicular block in forty fresh cadavers. Each approach was randomly done on each side of the same body. To determine the accuracy of the needle tip encroachment on the epineurium, staining of methylene blue on the nerves was defined as the success of the nerve localization. The localization of methylene blue was observed and the correlation between the success rates of the dye stained on the nerve trunk and the length of the patient’s neck was analyzed. Results: The success rate of three - nerve - trunk localization was 62.5 % by the lower interscalene approach, compared with 40 % by the classical approach (p value = 0.037). The success rates of superior, medial and inferior nerve trunk localization in the lower interscalene group were 70.0 %, 92.5 % and 97.5 %, compared with 67.5 %, 87.5 % and 65.0 % in the classical group, respectively. Their p values were 0.5, 0.355 and 0.001 respectively. There was neither correlation between the succsess rate of nerve localization and the clavicle length nor the neck length, but there was significant correlation between the success rate of three - nerve - trunk localization and the needle insertion depth in the classical group (p value = 0.031). Conclusion: Compared with the classical approach, the lower interscalene approach obtained more spreading of methylene blue on the brachial plexus as well as on the inferior nerve trunk. The authors therefore recommend the lower interscalene approach as the novel landmark for more success of supraclavicular block.

The Effect of Ketamine Added to a Ropivacaine Supuraclavicular Brachial Plexus Blockade / 대한마취과학회지

BACKGROUND: In addition to its general anesthetic effect, ketamine has a local anesthetic-like action by a peripheral mechanism. We evaluated the effects of injecting ketamine 45 mg in a supraclavicular brachial plexus blockade (SBPB) with 0.5% ropivacaine 150 mg. In addition, we evaluated the incidence of side effects. METHODS: Thirty four adult patients scheduled for upper extremity surgery were randomly allocated to one of three groups; group 1 (placebo group, n = 10) received 0.5% ropivacaine 30 ml for SBPB and intravenous saline 0.9 ml, group 2 (ketamine group, n = 13) received 0.5% ropivacaine 30 ml with ketamine 0.9 ml (45 mg) for SBPB, and group 3 (control group, n = 8) received 0.5% ropivacaine 30 ml for SBPB and intravenous ketamine 0.9 ml (45 mg). At 1-minute intervals after SBPB, patients were assessed for loss of shoulder abduction, elbow flexion, and wrist flexion, and for loss of pinprick sensation in the deltoid, radial, median, and ulnar dermatomes. Side effects and sedation scores were recorded at 5-minute intervals after SBPB. Before discharge, patients were asked when full sensation or motor function recovered. RESULTS: The speeds of onset for both the motor and sensory blocks were similar in all three groups. The duration of postoperative analgesia and paralysis were similar in the three groups. Side effects were experienced by 62% of patients in group 2 and by 100% of patients in group 3. CONCLUSIONS: We found that the addition of ketamine (45 mg) to brachial plexus blockade does not offer either a quicker onset or a longer duration of anesthesia when using 0.5% ropivacaine SBPB, and it caused a relatively high incidence of side effects.