Can we gain an advantage by combining distal median, radial and ulnar nerve blocks with supraclavicular block? A randomized controlled study.

Abstract

The aim of this study was to compare the combined ultrasound-guided supraclavicular brachial plexus block (SCB) and distal median, radial, and ulnar nerve blocks, with the supraclavicular block alone. Sixty-two patients undergoing upper extremity surgery were randomized to supraclavicular only (Group S, n=31) or supraclavicular+distal (Group SD, n=31) group. Patients in Group S received 32mL of 1.5% lidocaine+epinephrine 5µg/mL, while those in Group SD received 20mL of 1.5% lidocaine+epinephrine 5µg/mL followed by distal median, radial, and ulnar nerve blocks using equal volumes of 2% lidocaine+0.5% levobupivacaine (4mL/nerve). Sensory and motor blocks of the ulnar, median, radial and musculocutaneous nerves were assessed every 5min starting at the 10th minute. The imaging, needling and performance times were recorded. Also, the onset and anesthesia-related times, need for analgesic and first analgesic times, were noted. In Group SD, the anesthesia onset [15 (10-25) vs. 20 (15-30) min, p<0.001] and anesthesia related times [16.6 (10.7-28.2) vs. 22 (15.9-33.7) min, p<0.001] were significantly shorter than those of Group S. Additionally, the analgesic requirement was lower in Group SD (56.7 vs. 88.5%, p=0.009), while among the patients who required analgesic, the first analgesic time was longer in Group SD in comparison to Group S [625 (347-1764) vs. 315 (233-746) min p<0.001]. The addition of distal median, radial, and ulnar nerve blocks to SCB shortens anesthesia-related time and anesthesia onset time when compared with a SCB alone.