Abstract
Purpose
The purpose of this study is to determine if real time ultrasound guidance improves the success rate of axillary brachial plexus blockade.
Methods
Patients undergoing elective hand surgery were randomly assigned to one of three groups. Axillary blocks were performed using three motor response endpoints in the nerve stimulator (NS) Group, real-time ultrasound guidance in the ultrasound (US) Group and combined ultrasound and nerve stimulation in the USNS Group. Following administration of a standardized solution containing 2% lidocaine with 1:200,000 epinephrine and 0.5% bupivacaine (total 42 mL), sensory and motor functions were assessed by a blinded observer every five minutes for 30 min. A successful block was defined as complete sensory loss in the median, radial and ulnar nerve distribution by 30 min. The need for local and general anesthesia supplementation and post-block adverse events were documented.
Results
One hundred and eighty-eight patients completed the study. Block success rate was higher in Groups US and USNS (82.8% and 80.7%) than Group NS (62.9%) (P = 0.01 and 0.03 respectively). Fewer patients in Groups US and USNS required supplemental nerve blocks and/or general anesthesia. Postoperatively, axillary bruising and pain were reported more frequently in Group NS.
Conclusion
This study demonstrates that ultrasound guidance, with or without concomitant nerve stimulation, significantly improves the success rate of axillary brachial plexus block.
Résumé
Objectif
Le but de cette étude est de déterminer si l’échoguidage en temps réel améliore le taux de succès du bloc du plexus brachial par approche axillaire.
Méthode
Des patients devant subir une chirurgie élective de la main ont été randomisés en trois groupes. Des blocs axillaires ont été effectués en utilisant: trois points de réponses motrices dans le groupe neurostimulateur (NS), l’échoguidage en temps réel dans le groupe échographie (EG), et l’échographie combinée à la stimulation nerveuse dans le troisième groupe (EGNS). Suite à l’administration d’une solution standardisée contenant de la lidocaïne 2 % avec épinéphrine (1:200 000) et de la bupivacaïne 0,5 % (total 42 mL), les fonctions sensitives et motrices ont été évaluées par un observateur neutre toutes les cinq minutes pendant 30 min. Un bloc réussi a été défini comme la perte complète de sensation dans la distribution des nerfs médian, radial et cubital après 30 min. La nécessité d’une anesthésie locale et générale supplémentaire ainsi que les effets négatifs post-bloc ont été documentés.
Résultat
Chez les 188 patients qui ont terminé l’étude, le taux de succès du bloc a été plus élevé dans les groupes EG et EGNS (82,8 % et 80,7 %) que dans le groupe NS (62,9 %) (P) =0,01 et 0,03 respectivement). Un nombre moins élevé de patients des groupes EG et EGNS a nécessité des blocs nerveux supplémentaires et/ou une anesthésie générale. Après l’opération, les hématomes et douleurs axillaires ont été plus fréquemment observés dans le groupe NS.
Conclusion
Cette étude démontre que l’échoguidage, avec ou sans neurostimulation concomitante, améliore de façon significative le taux de succès du bloc du plexus brachial par approche axillaire.
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Funded by: Physician Services Incorporated and Canadian Anesthesiologists’ Society, Smiths Medical Canada Ltd. Canadian Research Award in Pain Research and/or Regional Anesthesia.
Equipment support by: Philips Medical System.
An erratum to this article is available at http://dx.doi.org/10.1007/BF03022334.
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Chan, V.W.S., Perlas, A., McCartney, C.J.L. et al. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anesth 54, 176–182 (2007). https://doi.org/10.1007/BF03022637
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DOI: https://doi.org/10.1007/BF03022637