Vijaya Ananth, P (2015) A Comparision of Ultrasound Guided Supraclavicular and Infraclavicular Blocks for Forearm and Hand Surgeries. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Surgical procedures involving hand and forearm can be performed either with general anaesthesia or regional anaesthesia techniques. The benefits of performing a surgery under regional anaesthesia far outweighs the risks of general anaesthesia. Brachial plexus block has stood the test of time for upperlimb surgeries. Initially brachial plexus block was done through interscalene, supraclavicular and axillary approaches. Infraclaviclar block has developed recent times. Initially nerve block was performed with parasthesia technique followed by nerve stimulator technique. Since the introduction of ultrasound into clinical practice, it has become a valuable adjuvant for peripheral nerve blocks. Initially used in conjunction with nerve stimulation, ultrasound guidance has increasingly been used as the sole to localize and anaesthetize the brachial plexus. OBJECTIVES: We aimed to determine the success of upper limb block based on number of patients reaching: 1. sensory block at radial, median, ulnar and musculocutaneous nerve distribution, 2. motor block at elbow, wrist and hand grip level, 3. complete sensory block, 4. complete motor block, 5. effective upper limb block, 6. surgical block among the two groups. Also to assess the block performance time and adverse events like accidental vessel puncture, Horner’s syndrome and pneumothorax. MATERIALS AND METHODS: We recruited 120 patients in this study after obtaining institutional ethical committee approval. These patients were aged between 18-50 years, and belonged to ASA class I or II. They were randomly allocated into two groups. Group-S-patient received ultrasound guided supraclavicular block and Group-I –patient received ultrasound guided infraclavicular block. The patients were evaluated for the 1. sensory block at radial, median, ulnar and musculocutaneous nerve distribution using a three point scale. (anaesthesia -score 2 –no pain, no touch sensation, analgesia - score 1 –no pain, pain - score 0 – feels pain). 2. motor block at the level of elbow, wrist and hand grip level using a three point scale. (paralysis -score 2 –no contraction, paresis – score 1 –reduced contraction, no weakness score 0 –normal contraction). 3. complete sensory block in all four nerve territories. 4. complete motor block in all three joints motor components. 5. effective upper limb block. 6. surgical block. The block performance time was also noted. And the patients were observed for the adverse events like; a) accidental vessel puncture, b) Horner’s syndrome, and c) pneumothorax. The results were tabulated and analysed using the SPSS software version 16. RESULTS: The two groups were comparable in terms of age, sex, and weight distribution with the ‘p’ value of 0.105 for age, 0.136 for sex and 0.077 for weight. Other demographic parameters such as duration of surgery and surgical area distribution also comparable with the ‘p’ value of 0.0931 and 0.593. No difference were observed between the two groups in terms of sensory block in the areas distributed by radial, median and musculocutaneous nerve with the ‘p’ values of 1.000,0.315 and 1.000. The I –Group patients had a significantly better block in the ulnar nerve distribution than the S-Group patients with the ‘p’ value of 0.013. For motor block no significant results were observed between the two groups at elbow and wrist level with the ‘p’ value of 1.00 and 0.648.The S-Group patients were poor motor block at hand grip level than I-Group patients with the ‘p’ value of 0.013.Complete sensory block is superior in the I-Group : 91.7% vs 76.7% in the S-Group with the ‘p’ value of 0.013.Complete motor block is also superior in the I-Group: 88.3% vs 75% in the S-Group with the ‘p’ value of 0.018. Effective upperlimb block is inferior in the S-Group (68.3%) compared with I-Group (88.3%) with the ‘p’ value of 0.009.No difference were observed between the two groups for surgical block with the ‘p’ value of 1.000. Compared with the S-Group, the I-Group had a longer block performance time (416.48 seconds [SD-20.550] vs 894.92 [SD-57.063] with the ‘p’ value of 0.000. The I-Group resulted in a higher rate of accidental vessel puncture (36.7 % vs 11.7 %) than the S Group with the ‘p’ value of 0.001. No difference were observed for the adverse events like Horner’s syndrome and pneumothorax with the ‘p’ value of 1.000 for both the events. CONCLUSION: Ultrasound guided peripheral nerve block have a higher rate of success for achieving surgical anaesthesia. Our study showed 100% success rate for both the groups in view of surgical aneathesia. Inspite of taking longer time for block performance and higher incidence of accidental vessel puncture, infraclavicular group is better than the supraclavicular group, for complete sensory, complete motor and effective surgical block. Other than accidental vessel puncture in infraclaviclar group, complications like Horner’s syndrome and pneumothorax were not observed in both the groups.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Supraclavicular block ; Infraclavicular block ; Brachial plexus ; Ultrasonogram. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Punitha K |
| Date Deposited: | 07 May 2018 03:49 |
| Last Modified: | 08 May 2018 04:46 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7572 |
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