A comparative study to evaluate the efficacy of ultrasound guided brachial plexus block and peripheral nerve block for upper limb surgeries

Abstract

Introduction: Ultrasound is gaining popularity in routine anesthetic practice both in operating room as well as in intensive care units. Brachial plexus block and peripheral nerve block in various combinations have been used successfully for upper limb surgeries. But the disadvantage of brachial plexus block is the inability to use the affected limb in the post operative period due to motor block. The present study was undertaken to assess the degree of motor sparring under USG guided peripheral nerve block as compared to USG guided brachial plexus block. Materials and Methods: The study was a randomized open label study conducted in two groups viz. group A and group B. Patients in group A received treatment A i.e peripheral nerve block (PNB) and patients in group B received treatment B i.e brachial plexus block. Results: In peripheral nerve block group the median strength loss was 23% whereas the same was 100% in brachial plexus block group. This difference was found to be statistically significant (????=0.001). The anesthetic onset time was found to be significantly shorter in peripheral nerve block group as compared to brachial plexus group (7.71+1.3 Vs 9.58 +1.91 min). Subject’s satisfaction score was reported higher with peripheral nerve block than those who underwent brachial plexus block: 5 Vs 4 respectively (p = 0.012). Likewise these satisfaction scores were found to have inverse correlation with loss of strength in the operative limb (Spearman’s rho ?0.62 [p = 0.016] and Kendall’s tau ?0.55 [p = 0.025]). Conclusion: Therefore we conclude that ultrasound guided peripheral nerve block can be an effective alternative to brachial plexus block as a primary mode of anesthesia in hand surgeries of short duration. Keywords: Hand surgery, Peripheral nerve block, Brachial plexus block, Ultrasonography.