Comparison of peripheral nerve stimulator versus ultrasonography guided axillary block using multiple injection technique

Abstract

Background:The established methods of nerve location were based on either proper motor response on nerve stimulation (NS) or ultrasound guidance. In this prospective, randomised, observer-blinded study, we compared ultrasound guidance with NS for axillary brachial plexus block using 0.5% bupivacaine with the multiple injection techniques.Methods:A total of 120 patients receiving axillary brachial plexus block with 0.5% bupivacaine, using a multiple injection technique, were randomly allocated to receive either NS (group NS, n = 60), or ultrasound guidance (group US, n = 60) for nerve location. A blinded observer recorded the onset of sensory and motor blocks, skin punctures, needle redirections, procedure-related pain and patient satisfaction.Results:The median (range) number of skin punctures were 2 (2–4) in group US and 3 (2–5) in group NS (P < 0.001). No differences were observed in the onset of sensory block in group NS (6.17 ± 1.22 min) and in group US (6.33 ± 0.48 min) (P = 0.16), and in onset of motor block (23.33 ± 1.26 min) in group US and (23.17 ± 1.79 min) in group NS; P > =0.27). Insufficient block was observed in three patient (5%) of group US and four patients (6.67%) of group NS (P > =0.35). Patient acceptance was similarly good in the two groups.Conclusion:Multiple injection axillary blocks with ultrasound guidance provided similar success rates and comparable incidence of complications as compared with NS guidance with 20 ml 0.5% bupivacaine.

A rat model of nerve stimulator-guided brachial plexus blockade

“…19 Axillary blocks with US guidance exhibited similar success rates and complication rates as NS guidance. 20 Our study demonstrated the feasibility of a BPB rat model and confirmed the efficacy and safety of BPB under NS-guided conditions. Further studies should be performed to investigate the US-guided BPB model in rats and to compare US and NS guided-BPB in rats for the development of a safer and more convenient BPB method.…”

A comparative clinical study of ultrasonography-guided perivascular and perineural axillary brachial plexus block for upper limb surgeries

“…With the development of ultrasound technology, there is an increase in the success rate, shorter onset time, and decrease in the volume required for successful ABPB. [17]…”

Onset times and duration of analgesic effect of various concentrations of local anesthetic solutions in standardized volume used for brachial plexus blocks

“…The ultrasound-guided peripheral nerve blockade techniques ( Kapral et al., 1994 ) have several advantages for patients undergoing trauma surgery with infrequent complications ( Kettner et al., 2011 ; Neal, 2016 ). The variations of nerve structures can be visualized by sonography reducing the volume needed to achieve complete nerve blockade ( Harper et al., 2010 ; Riazi et al., 2008 ) with a high success rate ( Chan et al., 2007 ; Jochum et al., 2013 ; Kumar et al., 2014 ). Smaller doses of local anesthetics are associated with incomplete nerve blockades ( Barrington and Kluger, 2013 ), while higher doses are not recommended because of the potential risk of local anesthetic systemic toxicity ( Neal et al., 2010 ).…”