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

Abstract

Introduction: Supraclavicular brachial plexus block with classical approach is used to provide anaesthesia for orthopaedic upper limb surgeries. This approach is safe but not devoid of complication, therefore we compared a alternative lateral approach with classical approach in terms of sensory and motor blockade, tourniquet tolerance and complication. Material and Methods: After obtaining the ethics committee approval 64 patients posted for orthopaedic surgeries below mid humerus under supraclavicular block were enrolled. They were divided into two groups (32 each), Group C received classical approach and Group L received lateral approach with the help of nerve stimulator. A mixture of adrenalized 2% lignocaine (5-7mg/kg) and plain 0.5% bupivacaine (2mg/ kg)(total volume 30 ml) was used. Onset time of sensory and motor block, duration of sensory and motor block, duration of analgesia, tourniquet tolerance and complications (if any) were noted and compared in both the groups. Quantitative data were compared by using unpaired T test and qualitative data by using Chi-Square test and Fisher's Exact test (2X2 tables). Results: The mean times to onset of sensory and motor blockade and the mean duration of sensory and motor blockade did not differ between the two groups. Mean duration of analgesia with lateral approach is found to be longer but statistically not significant. Tourniquet tolerance was good and no pneumothorax observed in lateral approach. Conclusion: Lateral approach has shown to be a safe alternative to classical approach for supraclavicular brachial plexus block in terms of adequacy of block, tourniquet tolerance and complications.