ABSTRACT
Background This study investigated the success rate of ultrasonography (USG)-guided supraclavicular block using a single-point injection technique comparing it with multiple-point injection technique, in terms of nerve sparing, time taken to perform the procedure, time taken to onset of sensory and motor block. Materials and methods A total of 204 patients of American Society of Anesthesiologists (ASA) Status I and II, aged 18-60 years, with body mass index (BMI) ≤30 kg/m2, posted for upper limb surgeries were given USG-guided supraclavicular brachial plexus block with 15 mL of 0.5% Ropivacaine. The patients were randomly divided into group A (single-point injection) and group B (multiple-point injection), using an out-of-plane technique. Sensory and motor block was assessed for onset and maximum grade achieved, by using pinprick, cold, touch, and movement respectively. The efficacy of the block was tested by assessment in the territories of musculocutaneous, ulnar, radial, median, axillary, and intercostobrachial nerves. Procedural time was calculated from the insertion of the needle till the complete injection of the drug. Results Patients in both groups were comparable in terms of demography and ASA status. The success rate for group A was 60.8%, compared to 98% in group B. In group B, the intercostobrachial nerve was most commonly spared (7.84%), followed by ulnar (1.96%), and radial (0.98%). On the other hand, in group A, the most frequently spared nerves were ulnar and intercostobrachial (23.5% each), followed by radial (12.7%), axillary (10.8%), musculocutaneous (7.8%), and median nerves (6.9%). The onset of sensory and motor block was similar in both groups. The procedure time was longer in the multiple-point group. Conclusion Our observations suggest that nerve sparing is much lesser in the multiple-point injection technique used for USG-guided supraclavicular block. In a good number of patients using this technique, the intercostobrachial nerve gets blocked.
ABSTRACT
BACKGROUND AND AIMS: Various adjuvants have been added to local anesthetics in single shot blocks so as to prolong the duration of postoperative analgesia. The present study was conceived to evaluate the effect of dexmedetomidine as an adjuvant to ropivacaine for institution of supraclavicular brachial plexus block. MATERIAL AND METHODS: Ninety adult patients (ASA physical status I, II) scheduled for elective upper limb surgeries under ultrasound-guided subclavian perivascular brachial plexus block were allocated randomly into two groups; the study was designed in double-blind fashion. All patients received 20 ml 0.75% ropivacaine, in addition, patients in group A (n = 43) received 2 ml 0.9% normal saline and those in group B (n = 44) received dexmedetomidine (1 µg/kg body weight); total volume was made up to 22 ml with sterile 0.9% saline in both groups. The onset and duration of sensory and motor blocks, time to first request of analgesia, total dose of postoperative analgesic administration, and level of sedation were also studied in both the groups. All the data were analyzed by using unpaired t-test. P < 0.05 was considered significant. RESULTS: Sensory and motor block durations (613.34 ± 165.404 min and 572.7 ± 145.709 min) were longer in group B than those in group A (543.7 ± 112.089 min and 503.26 ± 123.628 min; P < 0.01). Duration of analgesia was shorter in group A (593.19 ± 114.44 min) compared to group B (704.8 ± 178.414 min; P < 0.001). CONCLUSION: Addition of dexmedetomidine to 0.75% ropivacaine in supraclavicular brachial plexus block significantly prolongs the duration of analgesia.
ABSTRACT
BACKGROUND AND AIMS: Supraclavicular approach to the brachial plexus may be associated with complications such as pneumothorax, inadvertent vascular puncture, inter-scalene block and neurovascular injuries. The present study was conceived to find out the variation in depth of brachial plexus to suggest the minimum length of needle required to effectively perform the block, thus preventing possible complications. METHODS: After approval from our Institutional Ethical Committee, informed and written consent was obtained from each of the ninety American Society of Anesthesiologists Physical Status I and II patients recruited, of either sex in the age group of 20-50 years. Supraclavicular fossa was scanned using a high-frequency linear probe, and the distances (shortest distance [SD] from skin to the most superficial neural element and longest distance [LD] from skin to the most deep neural element) were measured using on-screen callipers on optimal frozen image. Pearson correlation was used to find out the relation between these two distances and demographic parameters. RESULTS: Mean SD was 0.60 ± 0.262 cm, and mean LD was found to be 1.34 ± 0.385 cm. We observed significant correlation between these two distances with weight and body mass index (BMI). CONCLUSION: Significant correlation was observed between SD and LD with weight and BMI. We suggest that a needle with a shaft length of 3 cm will be sufficient to reach the sheath of the brachial plexus during performance of the block.
ABSTRACT
Lung isolation is being used more frequently in both adult and paediatric age groups due to increasing incidence of thoracoscopy and video-assisted thoracoscopic surgery in these patients. Various indications for lung isolation and one-lung ventilation include surgical and non-surgical reasons. Isolation can be achieved by double-lumen endotracheal tubes or bronchial blocker. Different issues arise in prone and semi-prone position. The management of hypoxia with lung isolation is a stepwise drill of adding inhaled oxygen, adding positive end-expiratory pressure to ventilated lung and continuous positive airway pressure to non-ventilated side.
