Prabhu, M S (2013) Comparison of Lateral Approach and Subclavian Perivascular Approach of Supraclavicular Block. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION Regional anaesthesia enables site specific, long lasting and effective anaesthesia and analgesia. Brachial plexus block is a valuable addition to a general anaesthetic for surgery of the upper limb or a suitable alternative to general anaesthesia in certain patients.Brachial plexus blocks are among the most commonly performed, and most commonly studied peripheral blocks owing to their success rate and their ability to provide prolonged postoperative analgesia. In addition, the sympathetic block produced is of value for arm or hand reimplantation surgery or to establish a vascular shunt for dialysis. It has a major impact on patient outcome such as patient satisfaction and early mobilization. Although many approaches to the brachial plexus have been described, there are traditionally four anatomic locations where local anaesthetics are deposited. 1. The interscalene groove near the cervical transverse process, 2. The subclavian sheath at the first rib, 3. Near the coracoid process in the infraclavicular fossa 4. Surrounding the axillary artery in the axilla. Interscalene block is often useful for shoulder and upper arm surgery, but it has various complications like accidental vertebral artery injury, phrenic nerve and recurrent laryngeal nerve paralysis, rarely central neuraxial blockade and in this blockade ulnar nerve is frequently spared. Supraclavicular block has various advantages like high success rate, dense blockade and devoid of interscalene block complications. But accidental vessel injury and pneumothorax can occur in this technique. Infraclavicular block has decreased incidence of pneumothorax, arterial injury and it is an ideal site for continuous catheter placement. But it is the most painful approach when compared to other approaches because the plexus is deeply placed in this location, hence both the pectoralis major and pectoralis minor muscles will have to be pierced to reach the plexus. Axillary block can be easily performed and individual nerves can be blocked in this site but sparing of musculocutaneous nerve and intercosto brachial nerve is common in this approach. AIM OF THE STUDY: To compare lateral approach and subclavian perivascular approach of supraclavicular brachial plexus block using peripheral nerve stimulator in view of number of attempts, procedure time, success rate and complications in patients undergoing surgery below midarm. MATERIALS AND METHODS: This is a prospective randomized study conducted at Government Stanley Hospital, attached to Stanley Medical College, Chennai . Sixty patients of ASA grade I or II of either sex undergoing surgery below mid arm in plastic surgery department were randomly allocated into two groups S and L. Each group comprises of 30 patients. Surgery was done under supraclavicular brachial plexus block using peripheral nerve stimulator. In group S subclavian perivascular approach and in group L lateral approach was used. PROCEDURE: After ethical committee approval, informed consent was obtained from the patients. Intravenous access was obtained. Anaesthesia machine checked resuscitative equipment and drugs were kept ready. Inclusion criteria : 1. Age 18-65 yrs, 2. ASA I & II patients, 3. Surgery of upper limb below midarm. Exclusion criteria : 1. ASA III & IV, 2. Clavicular fracture. Coagulopathy Pregnancy, 3. Severe cardiopulmonary compromise, 4. Mentally challenged or language barrier Anatomical variations. OBSERVATION AND RESULTS: This study comprised of two groups. The patients were randomly selected. Group-L : 30 patients received Supraclavicular block by Lateral approach. Group-S : 30 patients received Supraclavicular block by Subclavian perivascular approach. Statistical Tools: The data were analyzed using SSPS (Statistical package for Social Science) Ver 16.01. The data collected were scored and analyzed. Continuous variable were presented as means with Standard deviation (Sd) and categorized variables were presented as frequency and percentages. Student t test was used for testing the significance of all the variables in both the group. Qualitative data was analyzed by using Chi square test. All the statistical results were considered significant at p value < 0.05. SUMMARY: 60 patients of ASA grade I and II undergoing upper limb surgeries were randomly assigned into two groups, Group L and Group S In this randomized prospective study, 30 patients received Lateral approach of supraclavicular brachial plexus block in group L, and other 30 patients received a Subclavian perivascular approach of supraclavicular brachial plexus block in group S. Surgeries below the level of mid arm were selected for this study. Parameters observed were – number of attempts, procedure time, complications, success rate. Study shows that: 1. 2 attempts wereneededto perform a block in 4patients of Group S and 1 patient of Group L. But the number of attemptsrequired to perform a block in both group was statistically insignificant. 2. Time to perform a block was not statistically significant in Group L andGroup S. 3. The incidence of complications in the form of vascular punctureobserved in 4 patients of Group S, which wasstatistically significant when compared to group S. 4. Success rate of blocking four terminal nerves (musculocutaneous, ulnar, radial, median,) was not statistically significant in group L when compared to group S. CONCLUSION: From our study it is inferred that in Supraclavicular brachial plexus block using nerve stimulator, Lateral approach is superior to subclavian perivascular approach in terms of less complication rate. But both approaches have high success rate if it is performed precisely using nerve stimulator.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Comparison ; Lateral Approach ; Subclavian Perivascular Approach ; Supraclavicular Block. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Apr 2018 17:18 |
| Last Modified: | 28 Apr 2018 18:24 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7262 |
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