Levobupivacaine in single-injection versus dual-injection ultrasound-guided supraclavicular brachial plexus block

Abstract

Background Ultrasound-guided supraclavicular block (US-SCB) can be achieved by needle maneuvering through the plexus ensuring local anesthetic deposition. Local anesthetic deposition at the corner pocket through a single path provides competent anesthesia mainly for the lower brachial plexus trunks. Our study hypothesized that dual path provides better block quality than single-path technique. Patients and methods This was a prospective randomized blinded study performed on patients undergoing upper limb surgery under US-SCB; patients were randomly allocated into two groups: in group S 30 ml of levobupivacaine 0.5% was injected in the corner pocket and in group D 15 ml was injected in the corner pocket and 15 ml was deposited in the center of the plexus. Sensory and motor blockades were recorded every 5 min until 30 min. The primary outcome was the percentage of patients achieving sensory and motor block over time interval, and the secondary outcome was total procedure time, incidence of paresthesia, time to sensory and motor recovery, and patient satisfaction. Results A total of 100 patients were equally allocated into two groups; early initial sensory block was achieved in 60% of patients (P = 0.028) and motor block in 86% of patients (P = 0.013) in the dual-injection group at 5 and 10 min, respectively. No significant difference was found in the percentage of patients progressed to sensory and motor blocks over time (P > 0.05). Paresthesia incidence in the dual group was 52% (P = 0.042), with no neurological adverse events. Significantly shorter total procedure time was observed in the single-injection group (P = 0.043). Conclusion Single US-SCB provides effective sensory and motor surgical block with less incidence of paresthesia and shorter performance time.