Abstract PR495

Abstract

Background & Objectives: Ultrasound (USG) guided brachial plexus block enables anesthesiologist to optimally deposit local anesthetic in real time to the target nerve thereby improving success rate and decreasing complications.1 The axillary approach to brachial plexus is commonly used for forearm,wrist and hand surgeries. The two USG guided techniques proposed for axillary block are perineural and perivascular. This study compares the performance,onset & total anaesthesia related time and success of block between two groups. Materials & Methods: A prospective randomized clinical trial was conducted in a tertiary care hospital.60 patients aged 18 - 65 yrs,ASA I&II who were undergoing forearm, hand and wrist surgeries were randomly assigned to one of two groups:perivascular (PV) and perineural (PN). The local anesthetic(12 ml of lidocaine 2% and 20 ml bupivacaine 0.5%) used in both groups was identical.In both groups, first musculocutaneous nerve was anesthetized with 8ml of drug. Subsequently in PV group, 24ml of drug was deposited around the artery whereas in PN group 8ml of drug was targeted at radial, median and ulnar nerves each after sonographic visualisation. During the procedure, the onset, performance and total anaesthesia related time and complications were recorded for both groups. The success rate and surgical anesthesia was assessed by blind observer. Performance time was taken as sum of imaging and needling time. Imaging time was defined as time taken to view all four nerves in case of PN block and axillary artery and musculocutaneous nerve in PV block. Needling time was calculated as time taken from needle insertion till delivery of drug.Total anesthesia time included performance time and onset time. Results: There was no difference observed between two groups in terms of success rate and total anesthesia related time.The complications included arterial puncture in 3 patients in PV group whereas none in PN group.Table:: Data analysis of both groupsConclusion: The PV and PN techniques are comparable in terms of success rate and total anesthesia related time. The PV technique provides a simpler alternative; however the onset is slower as compared to PN technique.The availability of block room makes latter a better option in institutions with high turn over of cases.