Ultrasound Versus Nerve Stimulator-guided Technique of supraclavicular nerve block for upper limb surgery: A prospective randomized comparative study

Abstract

Background: Peripheral nerve stimulator (PNS) guided and ultrasound (US) guided techniques allows better localization of the nerve/plexus. Ultrasound for supraclavicular brachial plexus block has improved the success rate of the block with excellent localization as well as improved safety margin. Aims and Objectives: To compare peripheral nerve stimulator guided technique and ultrasound guided technique of supraclavicular brachial plexus block for upper limb surgeries. Materials and Methods: We carried a prospective randomized single blind comparative study in 100 patients requiring upper limb surgeries. Supraclavicular brachial plexus block was given using 0.5% Ropivacaine. The sample were randomly allocated in to two groups of 50 each. Group US patients received supraclavicular brachial plexus block under ultrasound guidance and in Group PNS patients, nerve
stimulator guided technique was used. The parameters assessed were procedure time, onset and duration of sensory and motor blockade and complications. Statistical Analysis: Independent t‑ test was used to compare mean between groups; Chi‑ square test for categorical variables. Results: The procedure time was 8.2±1.32 minutes in group PNS and 6.34±1.02 minutes in group US (p˂0.0001). The onset of sensory and motor block was 7.79±1.21 minutes and 9.63±1.41 minutes in group PNS and 6.53±1.13 minutes and 8.01±1.18 minutes respectively in group US (p˂0.0001). The time to achieve complete block was 17.02±1.31 minutes in group PNS and 14.82±1.24 minutes in group US (p˂0.0001). The duration of sensory and motor block was 7 hours 10 minutes and 6 hours 15 minutes for group PNS and 8 hours and 7 hours respectively in group US. The success rate was 90% in group PNS and 96% in Group US. None of the patients in either groups developed any complications. Conclusion: The ultrasound‑ guided supraclavicular brachial plexus block can be done quicker, with a faster onset of sensory and motor block compared to nerve stimulator technique for supraclavicular brachial plexus block for upper limb surgeries.