The Effect of Single Point and Two Point Technique for Ultrasound Guided Supraclavicular Brachial Plexus Block in Patients Undergoing Elbow, Forearm and Wrist Surgeries- A Prospective Observational Study

Abstract

BACKGROUNDUse of ultrasound for brachial plexus block has improved the precision of drug deposition around the plexus and hence the quality of the block. But there has been debate whether single point technique or double point technique is superior. Our aim was to compare the two techniques for the onset, completeness and quality of the block. METHODSA prospective observational study was designed. 140 patients were equally divided into Group A and Group B containing 70 posted for elbow, forearm and wrist surgery. A drug solution of 30 ml was prepared using Ropivacaine 0.75% 15ml + Lignocaine 2% with adrenaline 10 ml + 5ml of normal saline. Group A received 30ml of drug at the lower end of brachial plexus at 7 O'clock position. Group B received 15 ml of drug at site mentioned above and 15 ml was given at the upper part of brachial plexus at 11 O'clock position. Parameters noted were time taken for giving block, onset and completeness of sensory and motor block, encircle time, total duration of block. Unpaired student t test used for comparing quantitative variables and Chi-square test for qualitative variables. p < 0.05 was considered statistically significant. RESULTSThe time required for giving the block was more in Group B (198.57 19.56 sec) compared to Group A (151.53  14.37 sec) but the encircle time in Group B (16  3.32 min) was lesser than Group A (19.01  3.6 min). The time of onset and completion of sensory and motor block for musculocutaneous, radial, ulnar and median nerve was faster in Group B compared to Group A. Duration of block in Group A was 367  50.49 minutes, whereas in group B 388  49.98 minutes. CONCLUSIONSIn ultrasound guided brachial plexus block, even though both techniques have satisfactory results, double point technique is superior to single point technique in terms of onset, completeness and duration of the block but in terms of simplicity in technicality single point technique has the upper hand.

Comparison of USG-Guided Supraclavicular Brachial Plexus Block by Single-Point Versus Multiple-Point Injection Technique: A Prospective Randomized Trial

“…[ 9 ], Pratap et al [ 12 ], Tran et al [ 13 ], and Arab et al [ 11 ] also observed that the single-point injection technique takes lesser procedure time. Choudhary et al [ 2 ], Jung et al [ 10 ], Murali et al [ 14 ], Tran et al [ 13 ], Pratap et al [ 12 ], Sherin et al [ 15 ], Arab et al [ 11 ], and Vallapureddy et al [ 9 ] all found delayed sensory and motor onset in the single-point injection group, compared to double- or triple-injection groups.…”