| JOURNAL HOME | CME HOME | THIS MONTH | PAST ISSUES | ETOC | COLLECTIONS |
| AUTHORS | REVIEWERS | EDITORIAL BOARD | FEEDBACK | RSS | HELP |
| ||||||||||||||
| ||||||||||||||
|
|
|
|
||||||||||||
|
||||||||||||||
Departments of *Anesthesiology and
Surgery, Centre Hospitalier de l’Université de Montréal, Hôpital Notre-Dame, Montréal, Quebec
Address correspondence and reprint requests to Philippe Chouinard, MD, FRCPC, Department of Anesthesiology, CHUM, Hôpital Notre-Dame, 1560 Sherbrooke East, Montreal, PQ, H2L 4M1. Address e-mail to philippe.chouinard.chum{at}ssss.gouv.qc.ca
In this prospective study, we assessed the quality, safety, and execution time of supraclavicular block of the brachial plexus using ultrasonic guidance and neurostimulation compared with a supraclavicular technique that used anatomical landmarks and neurostimulation. It was hypothesized that ultrasonic guidance would increase the proportion of successful blocks, decrease block execution time, and reduce the incidence of complications such as pneumothorax and neuropathy. Eighty patients were randomized into two groups of 40, Group US (supraclavicular block guided in real time by a two-dimensional ultrasonic image, with neurostimulator confirmation of correct needle position) and Group NS (supraclavicular block using the subclavian perivascular approach, also with neurostimulator confirmation). Blocks were performed using bupivacaine 0.5% and lidocaine 2% (1:1 vol) with epinephrine 1:200,000 as the anesthetic mixture. The onset of motor and sensory block for the musculocutaneous, median, radial, and ulnar nerves was evaluated over a 30 min period. At 30 min 95% of patients in Group US and 85% of patients in Group NS had a partial or complete sensory block of all nerve territories (P = 0.13) and 55% of patients in Group US and 65% of patients in Group NS had a complete block of all nerve territories (P = 0.25). Surgical anesthesia without supplementation was achieved in 85% of patients in Group US and 78% of patients in Group NS (P = 0.28). No patient in Group US and 8% of patients in Group NS required general anesthesia (P = 0.12). The quality of ulnar block was significantly inferior to the quality of block in other nerve territories in Group NS, but not in Group US; the quality of ulnar block was not significantly different between Groups NS and US. The block was performed in an average of 9.8 min in Group NS and 5.0 min in Group US (P = 0.0001). No major complication occurred in either group. We conclude that ultrasound-guided neurostimulator-confirmed supraclavicular block is more rapidly performed and provides a more complete block than supraclavicular block using anatomic landmarks and neurostimulator confirmation.
IMPLICATIONS: Ultrasound-guided neurostimulator-confirmed supraclavicular block is more rapidly performed and provides a block of better quality than supraclavicular block using anatomic landmarks and neurostimulator confirmation.
This article has been cited by other articles:
|
|
 |
|
  B. D. O'Donnell, H. Ryan, O. O'Sullivan, and G. Iohom Ultrasound-Guided Axillary Brachial Plexus Block with 20 Milliliters Local Anesthetic Mixture Versus General Anesthesia for Upper Limb Trauma Surgery: An Observer-Blinded, Prospective, Randomized, Controlled Trial Anesth. Analg., July 1, 2009; 109(1): 279 - 283. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Abrahams, M. F. Aziz, R. F. Fu, and J.-L. Horn Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials Br. J. Anaesth., March 1, 2009; 102(3): 408 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. R. Sauter, M. S. Dodgson, A. Stubhaug, A. M. Halstensen, and O. Klaastad Electrical Nerve Stimulation or Ultrasound Guidance for Lateral Sagittal Infraclavicular Blocks: A Randomized, Controlled, Observer-Blinded, Comparative Study Anesth. Analg., June 1, 2008; 106(6): 1910 - 1915. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. O'Sullivan Patient Comfort in Regional Anesthesia Anesth. Analg., January 1, 2008; 106(1): 349 - 349. [Full Text] [PDF]
|
|
|
|
|
|
A. Casati, M. Baciarello, S. D. Cianni, G. Danelli, G. De Marco, S. Leone, M. Rossi, and G. Fanelli Effects of ultrasound guidance on the minimum effective anaesthetic volume required to block the femoral nerve Br. J. Anaesth., June 1, 2007; 98(6): 823 - 827. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Marhofer and V. W. S. Chan Ultrasound-Guided Regional Anesthesia: Current Concepts and Future Trends Anesth. Analg., May 1, 2007; 104(5): 1265 - 1269. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Dingemans, S. R. Williams, G. Arcand, P. Chouinard, P. Harris, M. Ruel, and F. Girard Neurostimulation in Ultrasound-Guided Infraclavicular Block: A Prospective Randomized Trial Anesth. Analg., May 1, 2007; 104(5): 1275 - 1280. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Carty and B. Nicholls Ultrasound-guided regional anaesthesia CEACCP, February 1, 2007; 7(1): 20 - 24. [Full Text] [PDF]
|
|
|
|
 |
|
 C J C Cash, A M Sardesai, L H Berman, M J Herrick, G M Treece, R W Prager, and A H Gee Spatial mapping of the brachial plexus using three-dimensional ultrasound Br. J. Radiol., December 1, 2005; 78(936): 1086 - 1094. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Arcand, S. R. Williams, P. Chouinard, D. Boudreault, P. Harris, M. Ruel, and F. Girard Ultrasound-Guided Infraclavicular Versus Supraclavicular Block Anesth. Analg., September 1, 2005; 101(3): 886 - 890. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Marhofer, M. Greher, and S. Kapral Ultrasound guidance in regional anaesthesia Br. J. Anaesth., January 1, 2005; 94(1): 7 - 17. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Kane, W. Grassi, R. Sturrock, and P. V. Balint Musculoskeletal ultrasound--a state of the art review in rheumatology. Part 2: Clinical indications for musculoskeletal ultrasound in rheumatology Rheumatology, July 1, 2004; 43(7): 829 - 838. [Abstract] [Full Text] [PDF]
|
|
|
