Application of perineural space expansion by normal saline in axillary brachial plexus block / 上海交通大学学报（医学版）

ABSTRACT

Objective: To compare the clinical effect of ultrasound-guided perineural space expansion by normal saline combined with perivascular technique (PSE-PV) with traditional perivascular technique in axillary brachial plexus block (PV). Methods: A randomized, controlled, and double blind study was performed. Sixty patients arranged for emergency hand surgery were allocated to 2 groups, i.e. PSE-PV group and PV group, with 30 cases in each group receiving ultrasound-guided axillary brachial plexus block. For PSE-PV group, injection was carried out at the 12 o'clock position using 5 mL of normal saline firstly to expand the perineural space followed by 15 mL of 0.5% ropivacaine at the same position. The patients of PV group got their injections of 20 mL of 0.5% ropivacaine at the direction of 12 o'clock of axillary artery. The sensory and motor blockade assessment 30 min after drug injection, performance time, success rate, and adverse events were recorded. Results: The sensory and motor blockade scores were 1.7±0.3 and 1.6±0.3 in PSE-PV group, and 1.8±0.4 and 1.6±0.3, respectively in PV group without significant differences (P>0.05). The performance time of PSE-PV group was (4.0±1.3) min, a little longer than that of PV group, but the difference was not statistically significant (P>0.05). The success rates of nerve block reached 100% in both groups. Only 1 case in PV group reacted to the local anesthetics. Conclusion: Ultrasound-guided perineural space expansion by normal saline reduces dosage of local anesthetics in axillary brachial plexus block, which has similar anesthetic effect, performance time and adverse effect with traditional perivascular method.