Lateral Approach Of Supraclavicular Brachial Plexus As A Better Alternative To Conventional Supraclavicular Brachial Plexus Block

摘要

Purpose: Supraclavicular brachial plexus block technique, blocks the entire arm distally till mid arm level but risk of pneumothorax, phrenic nerve palsy and vascular puncture could be life threatening so to overcome these sequale we compared the lateral approach of supraclavicular brachial plexus block with conventional approach of supraclavicular block. Methods: Patients were randomly allocated in two groups; group 1 (n=50) received conventional approach of supraclavicular brachial plexus block and group 2 (n= 50) received lateral approach of supraclavicular brachial plexus block. Both the group received lignocaine with adrenaline (1:200000) 7 mg/kg and bupivacaine 2 mg.kg -1. The total volume of drug injected was 30 ml. Results: All the patients were assessed in terms of Time of onset of analgesia, Extent of sensory block, Quality of motor blocked, Tourniquet tolerance, Technical difficulty, Total duration of analgesia, Total duration of motor paralysis, and complications. Appropriate statistical analysis was done. Conclusion: We concluded that the Lateral Approach of Supraclavicular brachial plexus block justifies its own routine clinical uses because it has got better compliance of block in relation to onset, duration, extent and success rate. It is less traumatic and causes less adverse effects like puncture of vessels and pleura. Introduction Regional nerve blocks facilitate the surgery along with elimination of pain. Brachial plexus block is an accepted technique for upper limb surgeries, ambulatory anesthesia, cancer, postoperative and chronic pain management. Four approaches of brachial plexus blocks are in practice- axillary1, supraclavicular2, infraclavicular and interscalene. While axillary, supraclavicular and interscalene have become more popular, their limitation and sequelae have been overlooked and accepted. Supraclavicular technique blocks the entire arm distally till mid arm level, but the risk of pneumothorax, phrenic nerve palsy and vascular puncture could be life threatening. Ultrasound guided nerve blocks are now a routine practice in many parts of the world. However, the availability of an ultrasound in developing countries is limited. In absence of sophisticated tools, clinical landmarks are always useful. We hypothesized that a lateral approach to the brachial plexus could offer some advantage in preventing these complications. The present study of supraclavicular brachial plexus block by a lateral approach was carried out prospectively in a randomized manner. The clinical evaluation of supraclavicular brachial plexus block by lateral approach was performed in terms of the characteristics of sensory block, motor block, sequelae and complications. Material And Methods This prospective, randomized and blinded study was carried out after approval from local ethics committee and informed patient consent. Hundred adult patients of ASA grade I and II, of either gender, between the age group of 15-60 years, undergoing routine or emergency surgery for upper limb under brachial plexus block were enrolled for the study. Patients were randomly allocated to one of the two groups. In Group 1, patients received conventional approach of brachial plexus block and in Group 2; patients received lateral approach of brachial plexus block.All patients with co-existing medical conditions like hypotension, ischemic heart disease, diabetes, severe anemia, renal disease where general anesthesia was supposed to be associated with increased risk, were particular interest. Patients with anatomical distortion, scars, localized infection of upper arm, psychologically unfit patients, pregnant women, were excluded from this study. Before starting the procedure a baseline pulse rate, blood pressure, respiratory rate and oxygen saturation were recorded.All patients were kept nil orally for at least 6 hours before procedure and premedicated with intravenous glycopyrrolate 0.2 mg and midazolam 0.05 mg.kg -1Group 1: (Conventional approa