Comparison of Ultrasound Guided Technique with Conventional Landmark Technique for Supraclavicular Brachial Plexus Nerve Block in Patients Undergoing Upper Limb Surgery

Background: Brachial plexus blockade is a time tested anesthetic technique for upper limb surgeries. Among the various approaches of brachial plexus block, supraclavicular block, once described as the “spinal of the arm,” offers dense anesthesia of the brachial plexus for surgical procedures at or distal to the elbow. Landmark technique has been traditionally used for performing this block. But blind technique often requires multiple trial-and-error needle attempts, resulting in increase in procedure time, procedure-related pain and complications including pneumothorax, which is very risky. In developing countries like India, ultrasound is a relatively new technique and is increasingly being used for performing nerve blocks for acute as well as chronic pain procedures. Objective: We performed this study to evaluate safety and clinical usefulness of ultrasound technology for supraclavicular brachial plexus blocks. Methods: We included 60 adult patients of either sex undergoing surgeries for fracture of lower end of humerus or fracture of forearm bones. Patients were divided into two groups. In one group, surface landmark technique was used while in other group, supraclavicular nerve block was performed under ultrasound guidance by double injection technique. All patients received 10 ml each of 2% lignocaine with adrenaline, 10 ml 0.5% bupivacaine and 10 ml of saline. Surgery was started after confirming adequacy of block. Ineffective blocks were replaced with general anesthesia and insufficient pain control during surgery was supplemented with fentanyl. Results: There was no significant difference between patient groups with regard to demographic data. Supraclavicular plexus nerve block was placed in all 60 patients. Block failure was seen in 5 patients in landmark technique group and in one patient in USG group. The time of onset of sensory and motor block was shorter in USG group than landmark technique group. Intra-op analgesic was required in 5/30 patients in blind group and 3/30 patients in USG group. Post-op analgesia was for longer duration in USG guided group as compared to blind group. Conclusion: Ultrasound guidance is clinically very useful for supraclavicular brachial plexus block. It allows visualization of underlying structures, movement of needle and direct spread of local anesthetic and thus making the procedure safer and more effective.