A Prospective randomised study comparing lateral and posterior approach in ultrasound guided parasagittal in-plane infraclavicular brachial plexus block

Kathirvizhi, S (2017) A Prospective randomised study comparing lateral and posterior approach in ultrasound guided parasagittal in-plane infraclavicular brachial plexus block. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: Real time ultrasound guided peripheral nerve blockade revolutionized the field of regional anesthesia by enhanced visualisation of the neural target and spread of the local anesthetic agent. Brachial plexus can be approached at various levels, interscalene, supraclavicular, infraclavicular and axillary. Brachial plexus at the infraclavicular level lies deeper giving rise to impaired needle visualisation due to the steep angle of needle insertion in the lateral approach. Hence a newer posterior parasagittal approach was introduced, improving the needle visualisation and hence the block performance time. AIM OF THE STUDY: The aim of this randomised study was to compare the anaesthetic efficacy of ultrasound guided lateral parasagittal and posterior parasagittal approaches of infraclavicular brachial plexus block in forearm and hand surgeries. PRIMARY OBJECTIVES: The primary objectives of this study were to assess: 1. Sensory blockade of radial, median, ulnar and musculocutaneous nerves. 2. Motor blockade of radial, median, ulnar and musculocutaneous nerves. 3. Surgical anaesthesia. SECONDARY OBJECTIVES: The secondary objectives were to assess: 1. Total anaesthesia related time, 2. Procedural complications – Vascular puncture, accidental paresthesia, 3. Complications –pneumothorax, intravascular injection, features of local anaesthetic toxicity. MATERIALS AND METHODS: 110 patients undergoing surgeries of the forearm, wrist and hand in the hand were randomised into two groups. Group L received lateral approach (n = 55) and Group P received posterior approach (n=55). Probe was placed in the deltopectoral groove below the clavicle and medial to the coracoid process in both the groups. In Group L the needle was inserted at the cephalad aspect of the probe and in Group P needle insertion site was posterior to the clavicle over the trapezius muscle between the clavicle and the scapula along the direction of the axillary artery.30 ml of local anesthetic mixture was injected in both the groups. Block performance time, onset of surgical anesthesia, anesthesia related time, sensory and motor blockade were studied. RESULTS: The mean block performance time was 12.89 minutes in lateral group and 7.31 minutes in posterior Group (p=0.000). The duration of onset of surgical anesthesia was 17.25 minutes in Group L and 15.53 minutes in Group P (p=0.000). The duration of sensory and motor block was comparable in both the groups. There was no incidence of pneumothorax, local anesthetic toxicity or vessel puncture in any of the patients. DISCUSSION: A good visualisation of the needle with its tip during the entire course of performing the block, shortened the imaging time and needling time in posterior approach. The shorter onset time in posterior approach was due to the rapid onset of blockade in musculocutaneous and radial nerves. CONCLUSION: Ultrasound guided posterior parasagittal in plane infraclavicular brachial plexus block has short block performance time, onset time and hence faster anaesthesia related time with high success rate and no complications. Hence I conclude that posterior approach is a safe, reliable and feasible technique for ultrasound guided infraclavicular block.

Item Type: Thesis (Masters)
Additional Information: Reg.No.201420052
Uncontrolled Keywords: Brachial plexus, infraclavicular block, needle visualisation, parasagittal, posterior approach, lateral approach.
Subjects: MEDICAL > Anaesthesiology
Depositing User: Subramani R
Date Deposited: 21 Jul 2020 02:51
Last Modified: 21 Jul 2020 02:51
URI: http://repository-tnmgrmu.ac.in/id/eprint/12603

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