Ultrasonic guided brachial plexus block an upper limb surgery comparative study between different Approaches

Abstract

Regional anesthesia has more indication than general anesthesia since it covers not only the intra-operative but also the postoperative period. Brachial plexus blockade is used to provide regional anesthesia of the upper extremity in many different situation. Vascular, neurologic, orthopedic and other general surgery procedures and manipulation of the shoulder, arm, forearm and hand can be performed with this technique as result of the sensory and motor block that it provides. In elective surgery, the objectives differ from those in the emergency situation; brachial plexus block is one of the available anesthetic techniques. It is not indicated only for the intra-operative but also for postoperative analgesia, in which the brachial plexus block is very effective and long lasting. It also produces a ideal recovery from anesthesia while maintaining a potent analgesic effect in the postoperative period of analgesia that can extend up to 24 hours if adjuvants were used in combination with local anesthetic. Patients chosen for this study were ASA I-II-III .The study were carried out on 100 patients that were admitted to the hospital to undergo upper extremity surgery (fracture both bone forearm , supracondylar fracture humerus , post burn contracture elbow) with brachial plexus anesthesia . The patients were classified according to the technique into four groups (Interscalene group; Supraclavicular group; Infraclavicular group and Axilary group), 25 patients each; using ultrasound guided nerve block with ropivacaine.

In this work onset and degree of motor block to upper limb after brachial plexus block assessed by Bromage score, also onset of sensory block assessment of each individual nerve in upper limb of four groups after brachial plexus block has been done by pin prick test. Intra-operative hemodynamic variables (SBP, DBP, HR, SPo2) were recorded. Postoperative VAS pain score, time to first analgesic request, patient satisfaction and complication also were recorded. In this study as regard demographic data, there was no statistically significant difference (P > 0.05) in weight, age and gender among groups.