Ultrasound-Guided Interscalene Nerve Block: An Alternative Technique to Anatomical Landmark-Guided Approaches

Abstract

Background: The use of ultrasonography in interscalene brachial plexus block (ISBPB) has rapidly evolved over the past few years. It has been speculated that ultrasound guidance might increase success rates and reduce complications.Objective: The aim of our study is to compare the success rate and safety of ISBPB performed either with ultrasound visualization or with anatomical landmark to guide needle placement. Methods:A total of 44 patients scheduled for shoulder and upper arm surgeries in Zagazig University hospital, Zagazig, Egypt, were included in this prospective study and randomized into two equal groups according to the guidance method for ISBPB. In the ultrasound group (group A), the brachial plexus was visualized with a linear 38-mm, high frequency 7 MHz probe and the spread of the local anesthetic was assessed. In anatomical landmark group (group B), the roots of the brachial plexus were located by eliciting parasthesias when the target nerves were touched by the needle.Results: Surgical anesthesia was achieved in 91% of patients in group A vs. 73 % of patients in group B (p= 0.01). The dose of anesthesia was significantly lower in group A compared to group B. Also, duration of anesthesia was increased and the need for analgesia was reduced in group A. The incidence of complications was significantly higher in group B (45%) than in group A (18%) (p= 0.01). Conclusion:The use of ultrasonography helps to improve the efficacy and to reduce the complications associated with ISBPB.