Ultrasonographic Guidance Improves the Success Rate of Interscalene Brachial Plexus Blockade

Kapral, Stephan; Greher, Manfred; Huber, G; Willschke, Harald; Kettner, Stephan C.; Kdolsky, R.; Marhofer, Peter

doi:10.1016/j.rapm.2007.10.011

Cited by 134 publications

(148 citation statements)

References 13 publications

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“…These findings are similar to those of Kapral et al [18], who obtained 98% and 91% effective IBPBs with dual guidance and PNS confirmation alone, respectively, by administering 20 mL of 0.75% ropivacaine for trauma-related upper arm surgery. In contrast, Mejía-Terrazas et al [19] observed no difference in success rates between IBPBs performed with PNS assistance or ultrasound guidance.…”

Section: Discussionsupporting

confidence: 90%

Randomized, comparative study of the effectiveness of three different techniques of interscalene brachial plexus block using 0.5% ropivacaine for shoulder arthroscopy

Kolny

Stasiowski²,

Zuber

et al. 2017

Anaesthesiol Intensive Ther

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Background: Interscalene brachial plexus block is an effective regional anesthesia technique for shoulder surgeries. The superiority of the popular ultrasound-guided blocks over peripheral nerve stimulator-confirmed blocks remains unclear. In this study the efficacy of these different block techniques was compared. Methods: This prospective, randomized, clinical study included 109 patients (ASA grades I-III) who receive 20 mL 0.5% ropivacaine with ultrasound-guided blocks (U group), peripheral nerve stimulator-confirmed blocks (N group), or ultrasound-guided and peripheral nerve stimulator-confirmed blocks (dual guidance; NU group) for elective shoulder arthroscopy. Block onset time, duration, and effectiveness on the Lovett rating scale were assessed. Results: There was no statistically significant intergroup difference in duration of block performance, irrespective of the technique (P = 0.232). Onset time of complete warmth sensation loss (P < 0.001) and muscle strength abolition (P < 0.001) was significantly longer and mean Lovett rating scale score distribution was significantly higher in the N group than in the other groups (P < 0.001). These findings show a statistically significant correlation between the performance of the used block technique and the necessity of conversion to general anesthesia because of insufficient block in the N group (58.54%) than in the U (24.44%) and NU (19.57%) groups. Conclusions: Peripheral nerve stimulator-confirmed needle placement is not necessary to ensure effectiveness of ultrasound-guided blocks, which is expressed as a lack of necessity of conversion to general anesthesia. Nevertheless, the dual guidance technique is recommended to reduce the risk of complications and might be considered the regional anesthesia of choice for shoulder surgery.

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Section: Discussionsupporting

confidence: 90%

Randomized, comparative study of the effectiveness of three different techniques of interscalene brachial plexus block using 0.5% ropivacaine for shoulder arthroscopy

Kolny

Stasiowski²,

Zuber

et al. 2017

Anaesthesiol Intensive Ther

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“…In one large series (n = 5,964), Burgher et al 3 (Table 1). [2][3][4][5][6][7] By allowing the operator to visualise the nerve, needle and local anaesthetic spread, ultrasound guidance has been shown to improve the success and onset time for single shot nerve blocks of the upper 8,9 and lower 10 limbs. This has led many authors to advocate using ultrasonography for continuous nerve blocks as well.…”

Section: Discussionmentioning

confidence: 99%

Knotting of a Perineural Catheter Inserted with Ultrasonography

Duong¹,

Tran²,

Sinha³

et al. 2012

IJPUT

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Objectives: Increasingly, ultrasonography is being used to insert perineural catheters. We report the case of a knotted and retained interscalene catheter that required surgical extraction.Case report: An interscalene catheter was inserted to provide postoperative analgesia in a patient undergoing surgical repair of a proximal humeral fracture. Using ultrasound guidance, the needle tip was advanced in real time next the brachial plexus. Under direct vision, a bolus of local anaesthetic agents was injected and found to surround the plexic roots and trunks. Subsequently, a perineural catheter was inserted blindly past the needle tip. Postoperatively, removal of the catheter (at 24 hours) yielded unexpected resistance. An X-ray of the neck revealed the presence of a knot. The catheter was successfully removed with a surgical incision. The patient suffered no neurological sequelae. Conclusion:In order to maximise the benefits of ultrasound guidance for perineural catheter insertion, the operator should ensure that all steps (needle insertion, local anaesthetic injection and catheter advancement) be carried out under direct vision.

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“…C5 and C6 are the nerve roots of the brachial plexus. sensation and loss of motor function were assessed using the system that Kapral et al established [4]. Sensory dermatomes from C5 to C8 in the blocked arm were compared with similar dermatomes in the contralateral arm using pinprick (with a 21-G blunted needle) and a scale with 100% being normal sensation and 0% being insensate.…”

Section: Methodsmentioning

confidence: 99%

“…Motor block was evaluated by thumb abduction (radial nerve), thumb adduction (ulnar nerve), thumb opposition (median nerve), forearm supination or pronation (radial and median nerves) and shoulder abduction (axillary nerve). Motor function was evaluated using a seven-point scale developed by Kapral et al, where '6' is normal muscle force, '5' is slightly reduced muscle force, '4' is greatly reduced muscle force, '3' is slightly impaired mobility, '2' is greatly impaired mobility, '1' is near complete paralysis and '0' is complete paralysis [4].…”

Section: Methodsmentioning

confidence: 99%

Ultrasound‐guided interscalene blocks: understanding where to inject the local anaesthetic

Spence

Beach²,

Gallagher

et al. 2011

Anaesthesia

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SummaryAlthough ultrasound-guided regional anaesthesia has gained in popularity, few data exist describing the optimal location(s) to inject local anaesthetic. Our objective was to compare, for interscalene blocks, the effectiveness of an injection between the middle scalene muscle and brachial plexus sheath (peri-plexus) with an injection within the brachial plexus sheath (intra-plexus). We enrolled 170 patients undergoing shoulder surgery with general anaesthesia and interscalene block in this randomised, controlled trial. Our primary outcome variable was loss of shoulder abduction. Block quality was also measured and defined by an evaluation of onset time, sensory and motor loss and duration. There was no difference between the two groups in block onset times or block quality. After adjusting for sex, age and volume injected, intra-plexus blocks lasted a mean of 2.6 h (16%) longer (95% CI 0.25-5.01, p = 0.03) than peri-plexus blocks.

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Ultrasonographic Guidance Improves the Success Rate of Interscalene Brachial Plexus Blockade

Abstract: The use of ultrasound to guide needle placement and monitor the spread of local anesthetic improves the success rate of interscalene brachial plexus block.

Cited by 134 publications

References 13 publications

Randomized, comparative study of the effectiveness of three different techniques of interscalene brachial plexus block using 0.5% ropivacaine for shoulder arthroscopy

Randomized, comparative study of the effectiveness of three different techniques of interscalene brachial plexus block using 0.5% ropivacaine for shoulder arthroscopy

Knotting of a Perineural Catheter Inserted with Ultrasonography

Ultrasound‐guided interscalene blocks: understanding where to inject the local anaesthetic

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