Ultrasound-guided Continuous Supraclavicular Nerve Block versus General Anesthesia in upper limb surgeries

Abstract

Continuous peripheral nerve blocks provide site specific analgesia with least systemic effects. They could be effectively used for intra-operative anesthesia and as well as for very effective post-operative analgesia. The introduction of ultrasound into clinical practice has aided us to place these catheters in close proximity to the neural bundle.

Regional anesthesia has several reported advantages when compared with general anesthesia for patients undergoing upper limb trauma surgery, including improved perioperative analgesia, reduced opiate consumption, reduced postoperative nausea and vomiting (PONV), shorter postanesthesia care unit stay, and earlier hospital discharge. The supraclavicular brachial plexus block providescomplete anesthesia or analgesia of the upper extremityand is carried out at the level of the distal trunks/divisions of the brachial plexus. In the location thata supraclavicular block is carried out, the brachialplexus is in its tightest formation, thus allowing forrapid and complete anesthesia or analgesia of theupper limb. For this reason, a supraclavicular brachialplexus block has been called “spinal of the arm.”Continuous supraclavicular catheters can be used toprolong the duration of analgesia beyond that of asingle-injection technique.

In our study sixty patients scheduled for upper limb surgeries were assessed preoperatively for evaluation of their medical status, their laboratory investigations and for fulfilling the inclusion criteria. Patients were divided into 2 groups, the first group received ultrasound guided continuous supraclavicular brachial plexus nerve block while the second group received general anesthesia. The assessment of both groups was performed intraoperatively, and through 24hrs postoperatively including hemodynamics of the patients as heart rate, respiratory rate, mean arterial blood pressure and oxygen saturation.Time of the first rescue analgesia together with frequency and total dose of opiate through the 24 hours were measured.Pain severity was assessed using Visual analogue scale. Nausea was also measured using the category scoring system.

The study revealed that Ultrasound-guided Continuous Supraclavicular Nerve Block compared to General Anesthesia in upper limb surgeries, provided more stable hemodynamics in terms of heart rate and mean arterial blood pressure, superior pain relief, considerably less nausea and vomiting, less dose and frequency of administration of rescue analgesia doses. Previous studies came to an agreement to the result of our current study that Ultrasound-guided Continuous Supraclavicular Nerve Block ascertained more pain relief and less use of postoperative analgesics than General Anesthesia. It also provided less hospital stay and better economics.