Comparison of Lateral Approach With Conventional Approach of Supraclavicular Brachial Plexus Block: A Prospective Randomized Comparative Study

Abstract

Traditionally Supraclavicular Brachial plexus block is the commonly performed block for upper extremity surgeries. The Problems associated with this technique include inadequate block, failed block, direct injury to the nerves, pneumothorax, phrenic nerve palsy and vascular puncture etc. Recently lateral approach for supraclavicular brachial plexus block is gaining popularity because of its less complications and high success rate. The aim of the study is to compare the efficacy of lateral approach with conventional approach for supraclavicular brachial plexus block. METHODS: Fifty patients of ASA grade I and II scheduled for upper extremity surgery (below the midarm) were randomly allocated into two groups of 25 each. Group C was randomly allocated to receive supraclavicular brachial plexus block by conventional approach. Group L was randomly allocated to receive supraclavicular brachial plexus by lateral approach. Both the groups were given 10ml of 1.5% lignocaine and 15ml of 0.5% ropivacaine (total volume 25 ml).The parameters assessed were the onset and duration of sensory and motor blockade, time taken for the procedure, need for supplementation of anaesthesia, adverse effects, tourniquet tolerance and success rate. Statistical analysis was done using appropriate tests, (p<0.05) was considered statistically significant. We concluded that lateral approach for supraclavicular brachial plexus block using peripheral nerve stimulator, is a better alternative to conventional approach in terms of higher success rate and lesser complication rate. KEYWORDS: Brachial plexus block, Lateral approach supraclavicular brachial plexus block, Nerve stimulator, Lignocaine, Ropivacaine. INTRODUCTION:Brachial plexus block is a popular technique for upper limb surgeries, postoperative and chronic pain management. 1 Supraclavicular brachial plexus block is the common approach used for upper limb surgeries below the mid humerus. 2 The major advantage of supraclavicular block is that, the nerves are tightly packed in this area giving a very fast and deep block. Hence it is called as "The Spinal of the Arm". 3 However this approach has its own complications like direct injury to the nerves, puncture of subclavian artery, pneumothorax etc. 4 Recently lateral approach for supraclavicular brachial plexus block has gained popularity because of its low side effect profile and higher success rate compared to conventional approach. 5 Dr. Dilip Kothari has described this lateral approach for supraclavicular brachial plexus block and demonstrated that it was associated with minimal complications and high success rate.Ultrasound guided nerve blocks are being routinely done now a days, 6 however due to unavailability of ultrasound in our operating rooms, the present study was carried out using a nerve Page 8662 stimulator guided technique. 7,8 The aim of our study was to compare lateral approach with conventional approach for supraclavicular brachial plexus block, in terms of characteristics of sensory and motor blockade, success rate and comp...

Lateral Vs Classical Approach of Supraclavicular Brachial Plexus Block for Orthopedic Surgeries below Mid-Humerus: A Comparative Study.

“…In our study, Onset of sensory blockade with lateral approach was found to be earlier in comparison to classical approach. The results we found were similar to the study of Prasad PK et al 9 where time of onset of sensory blockade with lateral approach was found to be 8.5±1.25 minutes. In another similar study, A Kumar et al 10 found the time of onset of sensory blockade with lateral approach to be 7.33±4.17 minutes and with classical approach 11.77±4.07 minutes.…”

“…Partial block managed with 0.5mg/kg of intravenous ketamine. Prasad P.K et al 9 in similar study had found results comparable to our results. They found that 64% patients in classical group had totally effective block while 88% in Lateral group had totally effective block.…”

“…The mean duration of sensory and motor blockade also did not differ between the two groups. Similar results of duration of analgesia were found by Prasad PK et al 9 in their study where duration of analgesia with classical approach was found to be 220.68±15.25 minutes and with lateral approach to be 225.52± 18.28 minutes. A Kumar et al 10 found duration of analgesia with lateral approach was found to be 180.8±38.43minutes.…”

“…No patient had a failed block in our study. Prasad PK et al 9 in their study found complications like vessel puncture in 24% patients with classical approach while 4% patients with lateral approach; 4% had Horner's syndrome with classical approach while none had Horner's syndrome in lateral group; 20% had PONV in classical group and 12% had PONV in lateral group. In lateral approach needle is directed parallel to clavicle not inwards and downwards towards inlet, so the incidence of pneumothorax is nil.…”

USG Guided Supraclavicular, Vertical Infraclavicular and Coracoid Infraclavicular Approach of Brachial Plexus Block: A Double-Blind Comparative Study

“…BPB gives us a fully conscious patient, avoids polypharmacy, and provides better hemodynamic stability as well as an excellent post-operative analgesia [2]. Supraclavicular approach (SC) is most popular owing to high success rate and quick onset from tightly grouped nerves, which is superficial and easily visible under ultrasound, but complications like inadvertent intravenous injection of drugs, pneumothorax, phrenic nerve palsy and Horner's syndrome are more [2][3][4]. Despite of its remunerations of less complications & more consistent technique, clinical use of infraclavicular block (ICb) is not widespread [5].…”