Abstract
Background: Procedures that require anesthesia of entire length of the arm should have combined Interscalene block (ISB) and Supraclavicular block (SCB) to ensure adequate block. However, dual block requires high dose of local anesthetic (LA). We examined if Ultrasound (U/S) guided block helps to decrease the required volume of LA by visualizing trunks, so we only need injection of LA toward cervical nerve roots C5 and C6 aiming to block branches escaped from supraclavicular block. Patients and methods: Ninety-three patients were randomly allocated into one of three equal groups, each included 31 patients. All patients received SCB 20 ml (10 ml Bupivacaine 0.5% plus 10 ml lidocaine 2%) and ISB with different volumes of LA according to the group as follow: group A: 20 ml, group B: 15 ml, and group C: 10 ml. Result: No significant difference in onset of block (sensory and motor) and duration of block (motor only) between the three groups (P value > 0.05). The duration of sensory block was significantly longer in group A (760.65 ± 30.87 minutes) than in either group B (740.48 ± 21.15 minutes, P value P value P value P value P value P value < 0.001). Conclusion: A reduced volume of LA can be used in ultra sound guided ISB in combined with SCB to give satisfactory level of anesthesia to entire length of the arm, but the sensory block duration and duration of post-operative analgesia will be decreased significantly with decreasing the volume.
Highlights
Regional anesthesia for fractures of the proximal upper limb presents a challenge to the anesthetist as there is no single block that can provide a satisfactory level of anesthesia with high success rate
All patients received Supraclavicular block (SCB) 20 ml (10 ml bupivacaine 0.5% plus 10 ml lidocaine 2%) and Interscalene block (ISB) with different volumes of local anesthetic (LA) according to the group as follow: Group A: 20 ml, group B: 15 ml, and group C: 10 ml
As regards the sensory block duration, the results showed that; the duration of sensory block were increased in group A (760.65 ± 30.87) than in group B (740.48 ± 21.15) and group C (662.87 ± 31.28) and the difference in sensory block duration were statistically significant (P value < 0.001)
Summary
Regional anesthesia for fractures of the proximal upper limb presents a challenge to the anesthetist as there is no single block that can provide a satisfactory level of anesthesia with high success rate. The anesthetic management for surgical procedures that include the entire length of the humerus still includes general anesthesia either alone or combined with brachial plexus block [1]. Supraclavicular nerves are usually blocked with the brachial plexus when an interscalene block is performed This is because the local anesthetic invariably spills over from the interscalene space into the prevertebral fascia and blocks the branches of the cervical plexus [3]. Procedures that require anesthesia of entire length of the arm should have combined Interscalene block (ISB) and Supraclavicular block (SCB) to ensure adequate block. Conclusion: A reduced volume of LA can be used in ultra sound guided ISB in combined with SCB to give satisfactory level of anesthesia to entire length of the arm, but the sensory block duration and duration of post-operative analgesia will be decreased significantly with decreasing the volume
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