Ultrasound-guided Supraclavicular Block Research Articles

Axillary Brachial Plexus Block Compared with Other Regional Anesthesia Techniques in Distal Upper Limb Surgery: A Systematic Review and Meta-Analysis.

Background: Several regional anesthesia (RA) techniques have been described for distal upper limb surgery. However, the best approach in terms of RA block success rate and safety is not well recognized. Objective: To assess and compare the surgical anesthesia and efficacy of axillary brachial plexus block with other RA techniques for hand and wrist surgery. The attainment of adequate surgical anesthesia 30 min after block placement was considered a primary outcome measure. Additionally, successful block outcomes were required without the use of supplemental local anesthetic injection, systemic opioid analgesia, or the need to convert to general anesthesia. Methods: We performed a systematic search in the following databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and CENTRAL. RCTs comparing axillary blocks with other brachial plexus block techniques, distal peripheral forearm nerve block, intravenous RA, and the wide-awake local anesthesia no tourniquet (WALANT) technique were included. Results: In total, 3070 records were reviewed, of which 28 met the inclusion criteria. The meta-analysis of adequate surgical anesthesia showed no significant difference between ultrasound-guided axillary block and supraclavicular block (RR: 0.94 [0.89, 1.00]; p = 0.06; I2 = 60.00%), but a statistically significant difference between ultrasound-guided axillary block and infraclavicular block (RR: 0.92 [0.88, 0.97]; p < 0.01; I2 = 53.00%). Ultrasound-guided infraclavicular blocks were performed faster than ultrasound-guided axillary blocks (SMD: 0.74 [0.30, 1.17]; p < 0.001; I2 = 85.00%). No differences in performance time between ultrasound-guided axillary and supraclavicular blocks were demonstrated. Additionally, adequate surgical anesthesia onset time was not significantly different between ultrasound-guided block approaches: ultrasound-guided axillary blocks versus ultrasound-guided supraclavicular blocks (SMD: 0.52 [-0.14, 1.17]; p = 0.12; I2 = 86.00%); ultrasound-guided axillary blocks versus ultrasound-guided infraclavicular blocks (SMD: 0.21 [-0.49, 0.91]; p = 0.55; I2 = 92.00%). Conclusions: The RA choice should be individualized depending on the patient, procedure, and operator-specific parameters. Compared to ultrasound-guided supraclavicular and infraclavicular block, ultrasound-guided axillary block may be preferred for patients with significant concerns of block-related side effects/complications. High heterogeneity between studies shows the need for more robust RCTs.

Ultrasound-guided Supraclavicular Brachial Plexus Block with Ropivacaine in Basilic Vein Transposition Surgery for Chronic Renal Failure Patients: An Interventional Study

Introduction: Basilic Vein Transposition surgery (BVT) is preferred under ultrasound-guided supraclavicular brachial plexus block, which provides excellent and safe anaesthesia in Chronic Renal Failure (CRF) patients. Ropivacaine, with a shorter elimination half-life than bupivacaine and better pharmacokinetics, is a safer option as a local anaesthetic agent in CRF. Aim: To assess the onset and duration of sensory and motor blockade with 20 mL of 0.5% ropivacaine in ultrasound-guided supraclavicular block and the need for additional local infiltration at the surgical site for BVT. Materials and Methods: In present interventional study conducted in the Department of Anaesthesiology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India, 25 American Society of Anaesthesiologists (ASA) III/IV CRF patients, aged 18-80 years, who underwent BVT surgery, were included from December 2021 to November 2022. A 20 mL dose of 0.5% ropivacaine was administered to these patients via ultrasound-guided supraclavicular block. The surgeon performed local infiltration with 10 mL of lignocaine at the T2 dermatomal area in all patients. Descriptive statistics were calculated for age, weight, ASA status, onset and duration of sensory and motor blockade, and the need for additional local infiltration. Results: The mean age and mean weight of the patients were 52 years and 57.68 kg, respectively. Total 17 were male and eight were female, while 23 were ASA III and two were ASA IV. After administering the supraclavicular block, the mean onset of sensory and motor blockade was 9±2.3629 and 13.16±2.6721 minutes, respectively. The mean duration of sensory and motor blockade was 612.8±132.815 and 522.8±121.124 minutes, respectively. All patients required local site infiltration (10 mL of 1% lignocaine-Adrenaline) as the T2 dermatome is usually spared by the supraclavicular block. Three patients required additional local anaesthetic infiltration. Conclusion: Minimising the concentration and volume of local anaesthetic drugs without compromising efficacy is challenging, particularly in BVT, where the incision is extensive and performed under supraclavicular BPB in high-risk CRF patients. The anaesthesia practice of using a low volume of 0.5% ropivacaine in BPB under ultrasound guidance, along with local anaesthetic infiltration with 1% lignocaine with adrenaline at the T2 dermatome, can serve this purpose without any complications.

COMPARISON OF BUPIVACAINE ALONE AND BUPIVACAINE PLUS LIDOCAINE IN SUPRACLAVICULAR BLOCK UNDER ULTRASOUND GUIDANCE

This study aimed to compare the effectiveness of bupivacaine alone versus bupivacaine combined with lidocaine in patients undergoing ultrasound-guided supraclavicular block. Specifically, the study focused on the onset time and duration of the block effect. The study was designed as a retrospective study in the anesthesia room of the operation theater of Sheikh Zayed Hospital, Lahore, from 2nd November 2021 to 1st May 2022. A total of 200 patients who met the inclusion criteria were included in the study. Prior to the intervention, patients were given midazolam (2mg) to help alleviate anxiety. The participants were then divided into two groups, with 100 patients in each group. Group A received bupivacaine 20 ml (5 mg/ml), while Group B received bupivacaine 10 ml (5 mg/ml) in combination with lidocaine 10 ml (20 mg/ml). The onset and block effect times were recorded in a Performa and subjected to statistical analysis. The results of the study showed that the mean block onset time in Group A (bupivacaine alone) was 9.4±1.34 minutes, while in Group B (bupivacaine plus lidocaine), the mean block onset time was 5.4±0.83 minutes (p=0.000). A comparison of the mean block effect time revealed that in Group A, the mean block effect time was 4±1.34 minutes, while in Group B, the mean block effect time was 6±0.83 minutes. This difference was found to be statistically significant (p=0.000). In conclusion, the study demonstrated that the combination of bupivacaine plus lidocaine was significantly associated with a shorter block onset time and a longer block effect time compared to bupivacaine alone.

Optimal view detection for ultrasound-guided supraclavicular block using deep learning approaches

Successful ultrasound-guided supraclavicular block (SCB) requires the understanding of sonoanatomy and identification of the optimal view. Segmentation using a convolutional neural network (CNN) is limited in clearly determining the optimal view. The present study describes the development of a computer-aided diagnosis (CADx) system using a CNN that can determine the optimal view for complete SCB in real time. The aim of this study was the development of computer-aided diagnosis system that aid non-expert to determine the optimal view for complete supraclavicular block in real time. Ultrasound videos were retrospectively collected from 881 patients to develop the CADx system (600 to the training and validation set and 281 to the test set). The CADx system included classification and segmentation approaches, with Residual neural network (ResNet) and U-Net, respectively, applied as backbone networks. In the classification approach, an ablation study was performed to determine the optimal architecture and improve the performance of the model. In the segmentation approach, a cascade structure, in which U-Net is connected to ResNet, was implemented. The performance of the two approaches was evaluated based on a confusion matrix. Using the classification approach, ResNet34 and gated recurrent units with augmentation showed the highest performance, with average accuracy 0.901, precision 0.613, recall 0.757, f1-score 0.677 and AUROC 0.936. Using the segmentation approach, U-Net combined with ResNet34 and augmentation showed poorer performance than the classification approach. The CADx system described in this study showed high performance in determining the optimal view for SCB. This system could be expanded to include many anatomical regions and may have potential to aid clinicians in real-time settings.Trial registration The protocol was registered with the Clinical Trial Registry of Korea (KCT0005822, https://cris.nih.go.kr).

Comparison of landmark technique versus ultrasound guided technique for supraclavicular brachial plexus block in upper limb surgeries: A prospective randomized trial

: Brachial plexus block is a widely used regional anaesthesia technique for upper limb surgeries, with regional techniques gaining popularity over general anaesthesia. Recent advancements in anatomical sonography have improved the understanding and application of ultrasound-guided techniques. Ultrasound enables accurate needle placement /and real-time monitoring of drug distribution, enhancing the effectiveness and safety of the procedure.: The objective of this study is to compare the effectiveness of supraclavicular brachial plexus block using the landmark technique and ultrasound-guided technique in terms of procedure time, onset and duration of sensory and motor blockade, effectiveness of the block, and complication rate. This prospective, randomized controlled study included 60 patients aged between 18 and 60 years, of either sex, belonging to ASA grade I and II, and undergoing elective or emergency upper limb surgeries (elbow, forearm, and hand surgeries). The patients were divided into two groups: Group LM (Landmark technique) and Group US (Ultrasound technique). Each patient received a supraclavicular brachial plexus block using either technique with 25ml of 0.5% ropivacaine, and relevant parameters were recorded.: The success rate was higher in Group US compared to Group LM, and no complications were observed. The onset of blockade was significantly faster, and the duration of the block was longer with the ultrasound-guided technique compared to the landmark technique. However, the time taken to administer the block was longer with the ultrasound technique.: Ultrasound-guided supraclavicular block is a safer technique with a higher success rate, providing more effective and prolonged block compared to the conventional landmark technique.

Efficacy of intertruncal and corner-pocket approaches of ultrasound-guided supraclavicular block in terms of ulnar nerve blockade: A randomised controlled study.

The incidence of ulnar nerve sparing has declined with the corner-pocket approach of the supraclavicular block (SCB), however, it continues to persist. A recent technique of SCB, the intertruncal approach, separately blocks each trunk of the brachial plexus. Thus, we hypothesised that the intertruncal approach results in a complete ulnar nerve blockade. Eighty-eight patients were randomised to undergo SCB using an ultrasound (USG)-guided corner-pocket or intertruncal approach and were compared primarily regarding the complete sensory and motor blockade of the ulnar nerve and all four nerves (ulnar, radial, median and musculocutaneous nerves) at 15 min. Secondary objectives included time required for block performance, patient discomfort score, time to readiness for surgery and duration of sensory blockade of the ulnar nerve. Continous data were compared using an independent t-test, and categorical data were compared using the Chi-square test. The proportion of participants with complete sensory (30/44 vs. 14/44, P < 0.001) and complete motor (22/44 vs. 7/44, P < 0.001) blocks in the ulnar nerve and all four nerves at 15 min was significantly higher in the intertruncal group. Block performance time and patient discomfort score were higher in the intertruncal group (P < 0.001). The total duration of sensory blockade in the ulnar nerve was more in the corner-pocket group (P < 0.001). USG-guided intertruncal approach is superior to the corner-pocket approach of SCB regarding a complete ulnar nerve blockade.

Comparitive Study between Dexamethasone versus Fentanyl as Adjuvant to Local Anesthesia in Supraclavicular Nerve Block in Upper Limb Surgery

Abstract Background Peripheral nerve block as an anesthetic technique plays an important role in modern regional anesthesia. Upper limb surgeries are mostly performed under peripheral blocks such as the brachial plexus block. Peripheral nerve blocks not only provide intra-operative anesthesia, but also extend analgesia in the post-operative period without major systemic side-effects by minimizing stress response and using minimal anesthetic drugs. Objective To evaluate the effects of adding dexamethasone and fentanyl to bupivacaine in ultrasound guided supraclavicular brachial plexus block for upper limb surgery versus bupivacaine alone. Patients and Methods After obtaining approval from the medical ethical committee in Al-Matareya Teaching Hospital, this study was conducted in Al-Matareya Teaching Hospital in cooperation with Ain Shams University. It was include patients undergoing elective upper limb surgery. A written informed consent was obtained from every patient after explaining the procedure. A randomized double-blinded controlled study is thought to be the most suitable design to achieve the study objectives. Results The present study showed that addition of dexamethasone and fentanyl to bupivacaine in ultrasound-guided supraclavicular nerve block shortened the onset times of both sensory and motor blocks and significantly prolonged their duration compared to bupivacaine olny. Conclusion In the current study, the addition of dexamethasone or fentanyl to bupivacaine for supraclavicular brachial plexus block make the onset of sensory &amp; motor block faster and prolongation of motor and sensory block duration and prolongation of duration of analgesia more than using bupivacaine only. But onset of motor and sensory block was shorter in fentanyl group than dexamethasone group and duration of sensory and motor block more in dexamethasone rather than fentanyl.

Ultrasound guided suprascapular and supraclavicular nerve block in combination with continuous perineural brachial plexus block for operative management of upper limb multiple fractures: a case report

We report a case of multiple upper limb fractures resulting from a road traffic accident, wherein the patient declined general anesthesia. Instead, we successfully administered anesthesia using ultrasound-guided supraclavicular and suprascapular nerve blocks, combined with continuous perineural brachial plexus block. The surgical procedure was successfully completed within six hours, and no complications were encountered.

Effect of Intravenous Dexamethasone on the Duration of Analgesia Provided by Supraclavicular Brachial Plexus Block for Upper Limb Surgery

Background: Pain is associated with increased sympathetic activity leads to tachycardia, elevated blood pressure and myocardial insults so pain control is necessary during the surgery and in the postoperative period. Aim of the study was to study the effect of intravenous dexamethasone on the duration of analgesia provided by supraclavicular block (SCB) for upper limb surgery.&#x0D; Methods: 75 patients, age between 18 to 70 years of either sex, ASA class I and II, who were undergoing upper limb surgery randomized into three groups of 25 patients each by computer generated random number. Group S - 25 patients were given 5ml of normal saline intravenously along with ultrasound-guided SCB with 25ml 0.5% bupivacaine. Group DF - 25 patients were given 4mg intravenous dexamethasone in 5ml normal saline along with ultrasound-guided SCB with 25ml 0.5% bupivacaine. Group DE - 25 patients were given 8mg intravenous dexamethasone in 5ml normal saline along with ultrasound-guided SCB with 25ml 0.5% bupivacaine.&#x0D; Results: The demographic data were comparable in all groups. The VAS score was significantly lower in Group DF and DE compared to Group S at 3,4,6,8,10,12 and 24 hours, with p values &lt; 0.0001 at 3,4,5,6,8,10 and 12 hours and p value 0.0002 at 24 hours. The VAS scores between the groups DF and DE were comparable at 3,4,5,6,8,10,12 and 24 hours without any significant difference. The time for first rescue analgesia was significantly in Group DF and DE compared to Group S (p value &lt;0.0001). There was no significant difference between the groups DF and DE in the time for first rescue analgesia (p value 0.75).&#x0D; Conclusion: We conclude that dexamethasone used intravenously even in lower doses as 4mg along with supraclavicular brachial plexus block effectively increases the duration of analgesia and motor blockade, shortens the onset of sensory and motor blockade, reduces the total analgesic requirement in the first 24 hours after surgery.

Ultrasound-guided supraclavicular block versus Bier block for emergency reduction of upper limb injuries: a protocol for an open-label, non-inferiority, randomised controlled trial

BackgroundClosed reduction of upper limb fractures and/or dislocations are common in the emergency department (ED), which involves physically re-aligning the injured part prior to immobilisation. As this is painful, numerous techniques are available to provide regional anaesthesia to ensure patient tolerance. A Bier block (BB) is typically performed as part of routine care. An alternative technique gaining interest in the ED is ultrasound-guided supraclavicular block (UGSCB), which involves injecting local anaesthetic around the brachial plexus at the supraclavicular fossa under ultrasound guidance. It is unclear whether UGSCB is effective and safe when performed in the ED.MethodsSUPERB (SUPraclavicular block for Emergency Reduction versus Bier block) is a prospective open-label, non-inferiority randomised controlled trial that compares the effectiveness of UGSCB versus BB for closed reduction of upper limb fractures and/or dislocations. Adult patients presenting with an upper limb fracture and/or dislocation that requires emergent closed reduction in the ED will be eligible. After screening, participants will be randomised to either UGSCB or BB. Once regional anaesthesia is obtained, closed reduction of the injured part will be performed and appropriately immobilised. The primary outcome is maximal pain experienced during closed reduction measured via a visual analogue scale (VAS). Secondary outcomes include baseline and post-reduction pain, patient satisfaction, total opioid requirement in ED, ED length of stay, adverse events and regional anaesthesia failure.DiscussionExisting evidence suggests UGSCB is effective when performed in the operating theatre by trained anaesthetists. SUPERB will be the first randomised controlled trial to elucidate the effectiveness and safety of UGSCB in the ED. The findings have the potential to provide an alternative safe and effective option for the management of upper extremity emergencies in the ED.Trial registrationThis trial has been registered on 21 October 2022 with Australia and New Zealand Clinical Trials Registry (ACTRN12622001356752).

Comparative Study of The Effects of Three Different Volumes and Concentrations of Levobupivacaine on The Block Characteristics in Upper Limb Surgeries Using Ultrasound-Guided Supraclavicular Block

Comparative Study of The Effects of Three Different Volumes and Concentrations of Levobupivacaine on The Block Characteristics in Upper Limb Surgeries Using Ultrasound-Guided Supraclavicular Block

17. Ultrasound-guided Supraclavicular Block (USGB) by Surgeon for ORIF of Distal Radius Fractures (DRF): A 6-year Experience with 1830 Consecutive Cases

PURPOSE: Anesthesiologist need for preoperative testing for distal radius (DRF) ORIF delays care and increases costs. Familiar with ultrasound and anatomy, surgeons are well poised to deliver ultrasound guided supraclavicular block (UGSB.) We reviewed our experience with surgeon delivered UGSB without anesthesiologists to assess its safety and efficacy. METHODS: We retrospectively reviewed all DRFsORIF performed at our ASC by 3 surgeons over a 6-year period. Operative data, complications, demographics, clinical characteristics, fracture patterns, and functional outcomes were evaluated. RESULTS: 1,830 consecutive patients underwent ORIF without anesthesiologists; 1123 females, 707 males, age 62years (27-97). Six bilateral fractures. Fracture types: 783(A), 244(B) and 704(C); with 9 Gustilo(I), 4 Gustilo(II), and 92 malunions. Thirty-two distal ulnar fractures also required ORIF. 1,410 patients were ASA2, and 420 ASA3. Average time to administer block was 5.5min, tourniquet time 24.5min, and 63min total time patient spent in facility. Patients received no IV’s, self-ambulated to and from the OR table pain free, and conversed with the sitter nurse thru the procedure. 82 patients had partial UGSB failure requiring local lidocaine supplementation. No block related complications occurred except two transient unilateral phrenic nerve palsy. There were no infections, no hematomas and postoperatively required only 15 narcotic pills on the average (50% of historical). Upon discharge, 1,551 patients achieved normal range-of-motion, and 5 developed CRPS. Patient easily tolerated surgery without anesthesiologists and were highly satisfied with the expedited care and outcome. CONCLUSION: ORIF of DRFs can be safely, expeditiously, successfully, and cost-effectively treated by surgeon delivered UGSB without anesthesiologists and extensive preoperative testing.

Analgesic Efficacy of Dexmedetomidine as an Adjunct in Ultrasound-Guided Supraclavicular Block for Pediatric Upper Limb Surgeries: A Randomised Double Blind Controlled Study

Analgesic Efficacy of Dexmedetomidine as an Adjunct in Ultrasound-Guided Supraclavicular Block for Pediatric Upper Limb Surgeries: A Randomised Double Blind Controlled Study

Dexmedetomidine-bupivacaine versus ketamine-bupivacaine for ultrasound guided supraclavicular brachial plexus nerve block in upper arm orthopedic surgeries

Background: Seeking for efficient adjuvants to the regional nerve block is still under research, with medication that increases the time of analgesia but with lesser side effects. Objectives: The purpose of this research was to study the safety and efficacy of different additives, namely dexmedetomidine and ketamine when added to bupivacaine in ultrasound-guided supraclavicular block, to assess the onset and duration of sensory and motor block, sedation score, pain scale and to explore side effects dexmedetomidine and ketamine when added to bupivacaine in ultrasound-guided supraclavicular block. Patients and methods: This clinical study was carried out on 60 American Society of Anesthesiologists (ASA) I and II patients, aged 18–60 years, scheduled for upper limb orthopedic surgeries under supraclavicular brachial plexus block. Patients were randomly divided into two groups (30 patients each): group D received dexmedetomidine and bupivacaine and group K received ketamine and bupivacaine. Result: Regarding duration of sensory and motor block and duration of analgesia,) group D showed statistically significant longer duration values (413.97±87.31, 472.24±90.06 and 456.21 ± 97.99) respectively compared with group K (227.00±48.36, 292.67 ±59.13 and 289.67 ± 62.50) respectively (P value&lt; 0.05).

Dexmedetomidine as an adjunct to bupivacaine and xylocaine with adrenaline in ultrasound guided supraclavicular brachial plexus block in upper limb surgeries

Introduction: Supraclavicular brachial plexus block is widely used for perioperative anesthesia and analgesia. Dexmedetomidine is highly selective alpha-2 receptor agonist which provides analgesia, sedation and anxiolysis. Our study aims to evaluate the effect of addtion of dexmedetomidine with bupivacaine and xylocaine with adrenaline in supraclavicular block in upper limb surgeries.&#x0D; Method: This was a comparative study conducted at Patan Hospital, Patan Academy of Health Sciences, Nepal among 44 patients randomly assigned in Group-I (N=22, bupivacaine and xylocaine with adrenaline 28 ml + dexmedetomidine 2 ml (1 mcg/kg), and Group-II (N=22, without dexmedetomidine) for ultrasound-guided supraclavicular block for upper limb surgeries. The study was approved by institutional review committee. Onset of sensory and motor block, duration of analgesia, demographics, hemodynamic parameters, and side effects of drug were compared. Pin-prick test and modified Bromage scale were used to evaluate sensory and motor block. Visual analogue scale was used for severity of pain. Statistical analysis was performed with SPSS v.16.&#x0D; Result: The median time for onsets of sensory and motor block were significantly shorter in group I (1 m and 3 m) than group II (5 m and 10 m). The duration of analgesia was s longer in group I (720 m) than group II (360 m). Two patients had bradycardia and one hypertension in dexmedetomidine group whch were managed successfully.&#x0D; Conclusion: Dexmedetomidine added to local anesthetics significantly prolongs the effect of supraclavicular block in upper limb surgeries.

Efficacy comparison of magnesium sulphate, ketamine and neostigmine adjuvants to bupivacaine 0.5% on onset, duration and quality of ultrasound-guided supraclavicular block characteristics for forearm surgery

Efficacy comparison of magnesium sulphate, ketamine and neostigmine adjuvants to bupivacaine 0.5% on onset, duration and quality of ultrasound-guided supraclavicular block characteristics for forearm surgery

Evaluate the quality of successful ultrasound guided supraclavicular brachial plexus block and its correlation with perfusion index ratio

Background: Ultrasound-guided supraclavicular nerve block is a popular approach for anesthesia for upper limb surgeries. Perfusion index can considered as an objective measure for peripheral perfusion that can predict peripheral block success. Early and accurate detection of peripheral block success would enable rapid corrective action this would save the operating room time and improve patient satisfaction. The main objective was to evaluate the quality of supraclavicular brachial plexus block and it’s correlation with Perfusion Index ratio. Method: It was a prospective observational study carried out over a period of 18 months from November 2018 to April 2020 in the department of anesthesia. Patients aged between 18 to 65 years. Written informed consent, 30 patients of either sex, belonging to ASA grade I and II, scheduled for elective upper limb, under supraclavicular brachial plexus block were selected for the study. Quality of block was made on the basis of 3 point scale. Result: In this study we observed that the Perfusion index was significantly higher in blocked limbed at all time points.

Comparative study between intravenous versus perineural dexamethasone in prolonging the analgesic effect of supraclavicular plexus nerve block in hand surgeries

Abstract Background Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stays and an increased likelihood of chronic pain. Systemic analgesics (opioids and non-opioids) have long been used for postoperative pain, then neuroaxial or peripheral nerve blocks were employed. Local anesthetics alone were used, then various adjuvants were added to achieve quick, dense and prolonged block. Objective To study the effect of dexamethasone as an adjuvant to bupivacaine either intravenous or perineural in ultrasound guided supraclavicular brachial plexus block in hand surgeries regarding the onset of the block, the duration of the block, the effect on postoperative analgesic requirements as well as anticipated complications. Patients and Methods In our study, 50 patients were randomly divided into 2 equal groups. perineural group received bupivacaine (0.5%) concomitant with 8 mg dexamethasone and Systemic group in which 8 mg of dexamethasone were injected systemically. All patients received equal volumes of 20 milliliters. Results Our study showed that addition of a8 milligram of dexamethasone to bupivacaine in ultrasound-guided supraclavicular nerve block shortened the onset times of sensory and motor blocks and significantly prolonged their durations. In addition, dexamethasone prolonged the duration of analgesia of the plexus block significantly, as proved by the time of request of first analgesia. Moreover, in perineural dexamethasone group, postoperative analgesic requirements were greatly lesser than that of bupivacaine groups. Addition of dexamethasone perineural also did not affect the hemodynamics to a significant level. This makes perineural dexamethasone with bupivacaine more superior than the use of bupivacaine with addition of intravenous dexamethasone. Conclusion The use of ultrasonography in performing the supraclavicular nerve block, decreased significantly the incidence of complications such as pneumothorax or intravascular injection and hence, lowered the incidence of systemic toxicity of local anesthetics.

Hemidiaphragmatic paralysis following costoclavicular versus supraclavicular brachial plexus block: a randomized controlled trial

Costoclavicular brachial plexus block is emerging as a promising infraclavicular approach performed just below the clavicle. However, there are relatively little data regarding the hemidiaphragmatic paralysis (HDP) compared to the commonly performed supraclavicular block. We hypothesized that the incidence of HDP in costoclavicular block is lower than supraclavicular block like classical infraclavicular approach. Eighty patients were randomly assigned to ultrasound-guided supraclavicular (group S) or costoclavicular (group C) block with 25 mL of local anesthetics (1:1 mixture of 1% lidocaine and 0.75% ropivacaine). The primary outcome was the incidence of HDP, defined as less than 20% of fractional change in the diaphragm thickness on ultrasound M-mode. Also, pulmonary function test and chest radiograph were assessed before and after the surgery. The incidence of HDP was 4/35 (11.4%) in the group C and 19/40 (47.5%) in the group S (risk difference, − 36%; 95% CI − 54 to − 17%; P = 0.002). The mean (SD) change of DTF values were 30.3% (44.0) and 56.9% (39.3) in the group C and S, respectively (difference in means, − 26.6%; 95% CI − 45.8 to − 7.4%; P = 0.007). The pulmonary function was more preserved in group C than in group S. The determined diagnostic cut off value of the diaphragm elevation on chest radiograph was 29 mm. Despite the very contiguous location of the two approaches around the clavicle, costoclavicular block can significantly reduce the risk of HDP compared with supraclavicular block.

Pulse Oximeter Perfusion Index as a Predictor of Successful Supraclavicular Brachial Plexus Block

Abstract Objective Ultrasound-guided supraclavicular brachial plexus block is a popular anesthetic technique for upper limb surgeries. Assessing the success sensory and motor block using conventional methods is time consuming and also it needs patient co-operation. In the present study, objective method like increase in perfusion index is used to predict the success of ultrasound-guided supraclavicular block. Materials and Methods This prospective trial consists of total 95 patients undergoing elective upper limb procedures. All patients received ultrasound-guided supraclavicular block using 0.5% bupivacaine 20 mL. Sensory and motor blocks were evaluated every 5 minutes followed by pinprick testing and ability to flex the elbow and the hand against gravity, respectively. The perfusion index was measured using pulse oximetry applied on the index finger and recorded at baseline and 10, 20, and 30 minutes interval after local anesthetic injection in both the blocked limb and the contralateral unblocked limb using two separate pulse oximeters. Results Perfusion index increased in blocked arm after 5 minutes compared with unblocked arm and also to its baseline value. Both perfusion index and perfusion index ratio in blocked arm were found statistically significant. Conclusion To evaluate the success of supraclavicular block, perfusion index can be considered as a useful tool.