DOI: http://dx.doi.org/10.18203/2349-3933.ijam20183913

Ultrasound guided interscalene brachial plexus block via lower approach for upper limb surgeries

Roopal R. Garaniya, Sheetal Shah, Noopur Prajapati

Abstract


Background: Brachial plexus block via interscalene approach is an excellent option for upper limb surgeries, but due to sparing of ulnar nerve (lower trunk, C8-T1) and its’ complications, it is not so popular. To overcome this problem, interscalene block via lower approach has been tried which has more advantage in view of ulnar nerve blockage and also less complications. In addition, ultrasound provides reliability, ease, rapidity and also patient comfort during block procedure. This prospective study was performed to evaluate the anaesthetic effect of lower approach interscalene block with the help of ultrasound and peripheral nerve stimulator.

Methods: Ultrasound guided interscalene brachial plexus block via lower approach was given in randomly selected 30 patients, undergoing upper limb orthopaedic surgeries. After localisation of brachial plexus with ultrasound, the nerve roots were confirmed with the help of peripheral nerve stimulator, before injecting drug. At 5 and 15 min after block, all patients were assessed for the effect. Postoperatively they were assessed for any complication and also for their satisfaction level by Likert’s scale.

Results: In territories of ulnar, radial and musculocutaneous nerve there was 100% effect while in median nerve territory 92.8% motor block was there. There was no need of analgesics during intra operative period in any patient and there were no major complications with this approach.

Conclusions: Ultrasound guided interscalene block via lower approach is an excellent alternative for upper limb surgeries over classical approach in view of ulnar nerve blockage without any major complication.


Keywords


Brachial plexus, Interscalene block, Ultrasound

Full Text:

PDF

References


Jadon A, Dixit S, Kedia SK, Chakraborty S, Agrawal A, Sinha N. Interscalene brachial plexus block for shoulder arthroscopic surgery: Prospective randomised controlled study of effects of 0.5%ropivacaine and 0.5% ropivacaine with dexamethasone. Indian J Anaes. 2015;59(3):171-6.

Ip VH, Tsui BC. Lower interscalene approach for elbow surgery. Canadian J Anesthesia. 2013;60(6):600-1.

Park SK, Sung MH, Suh HJ, Choi YS. Ultrasound guided low approach interscalene brachial plexus block for upper limb surgery. Korean J Pain. 2016;29(1):18-22.

Soeding PF, Sha S, Royse CF, Marks P. A randomized trial of ultrasound-guided brachial plexus anaesthesia in upper limb surgery. Anaesthesia and intensive care. 2005;33(6):719.

Koscielniak‐Nielsen ZJ. Ultrasound‐guided peripheral nerve blocks: what are the benefits?. Acta Anaesthesiolog Scand. 2008;52(6):727-37.

Williams SR, Chouinard P, Arcand G, Harris P, Ruel M, Boudreault D, et al. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesthesia Analgesia. 2003;97(5):1518-23.

Liu SS, Gordon MA, Shaw PM, Wilfred S, Shetty T, YaDeau JT. A prospective clinical registry of ultrasound-guided regional anesthesia for ambulatory shoulder surgery. Anesthesia Analgesia. 2010;111(3):617-23.

Chan VW, Perlas A, Rawson R, Odukoya O. Ultrasound-guided supraclavicular brachial plexus block. Anesthesia Analgesia. 2003;97(5):1514-7.

Nadeau MJ, Lévesque S, Dion N. Ultrasound-guided regional anesthesia for upper limb surgery. Canad J Anesthesia. 2013;60(3):304-20.

Kessler J, Schafhalter-Zoppoth I, Gray AT. An ultrasound study of the phrenic nerve in the posterior cervical triangle: implications for the interscalene brachial plexus block. Regional Anesthesia Pain Med. 2008;33(6):545-50.

Laurent DB, Chan V, Chin KJ. Refining the ultrasound-guided interscalene brachial plexus block: the superior trunk approach. Canadian J Anes. 2014;61(12):1098-102.