A comparison of ultrasound versus paresthesia technique for supraclavicular brachial plexus block

Bidyut Borah, Smita R. Engineer, Kiran B. Patel


Background: Ultrasonography is a newer tool for identification of nerves in the practice of regional anaesthesia. Visualization of target structures and spread of drugs under direct vision and thus avoiding complications like pneumothorax, accidental intravascular injections are potential benefit of ultrasonography technique. Aim of the study was to examine the usefulness of ultrasound guided brachial plexus block and compare it with paresthesia technique with the believe that ultrasound guidance can shorten the onset as well as increase the duration of blockade..

Methods: Eighty patients of either sex, 18-60 years, posted for upper limb surgery were divided into 2 groups according to the technique used to give block, group US (ultrasound technique) and group PA (paresthesia technique).  Both the groups received 0.5 % bupivacaine 20 ml with 8 mg of dexamethasone.

Results: There was notable difference between the patient groups with regard to initiation of motor blockade (10 min group US vs 11.1 min group PA, p <0.0156) and sensory blockade (5.16 min group US vs 6.96 min group PA, p <0.0001) also duration of motor blockade (1272.88 min in group US vs 899.25 min in group PA, p <0.0001) and sensory blockade (1343.88 min in group US vs 996.75 min in group PA, p<0.0001).

Conclusions: Ultrasound guided supraclavicular brachial plexus blocks result in a higher success rate with respect to onset and duration of blockade with less incidence of complications compared to paresthesia technique.


Brachial plexus, Motor, Paresthesia, Sensory, Supraclavicular block, Ultrasound

Full Text:



Chan VW, Perlas A, Mccartney CJ, Brull R, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth. 2007;54:176-82.

Sarah MJ, Brian IM. Peripheal nerve block. In: Butterworth John F, Mackey David C, Wasnick john D, editors. Morgan and Mikhail’s Clinical anesthesiology, 5th ed. India: McGraw Hill; 2014:975-1022.

Mcleod G. Technique of regional anaesthesia. In: Davies NJH, Cashman JN, editors. Lee’s Synopsis of Anaesthesia, 13th ed. India: Elsevier; 2014:401-70.

Renes SH, Spoormans HH, Gielen MJ, Rettig HC, van Geffen GJ. Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2009;34:595-9.

WS Chan, Perlas A, Rawson R, Odukoya O. Ultrasound-guided supraclavicular brachial plexus block. Anesth Analg. 2003;97:1514-7.

Chao FL, Liou JT, Fong YT. Efficacy of ultrasound-guided axillary brachial plexus block: a comparative study with nerve stimulator-guided method. Chang Gung Med J. 2005;28:396-402.

Cummings KC, Napierkowski DE, Sanchez PI, Kurz A, Dalton JE, Brems JJ, et al. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. Br J Anaesth. 2011;107:446-53.

Vieira PA, Pulai I, Tsao GC, Manikantan P, Keller B, Connelly NR. Dexamethasone with bupivacaine increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade. Eur J Anaesthesiol. 2010;27:285-8.

Williams SR, Couinard P, Arcand G, Harris P, Ruel M, Boudreault D, et al. Ultrasound guidance speeds execution and improves the quality of supraclavicuar block. Anesth Analg. 2003;97:1518-23.

Hickey R, Garland TA, Ramamurthy S. Subclavian paravascular block: influence of location of parasthesia Anesth Analg. 1989;68:767-71.

Zetlaoui PJ, Labbe JP, Benhamou D. Ultrasound guidance for axillary plexus block does not prevent intravascular injection. Anesthesiology. 2008;108:761.

Marhofer P, Schrogendorfer K, Wallner T, Koinig H, Mayer N, Kapral S. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks. Reg Anesth Pain Med. 1998;23:584-8.

Searle A, Niraj G. Ultrasound-guided brachial plexus block at the supraclavicular level: A new parasagittal approach. Int J Ultrasound Appl Technol Perioper Care. 2010;1:19-22.

Marhof er P, Schrogendorfer K, Koinig H, Kapral S, Weinstabl C, Mayer N. Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg. 1997;85:854-7.