Clinical Comparison of Two Different Volumes of 0.5% Bupivacaine for Clavicular Surgeries Using Combined Interscalene and Superficial Cervical Plexus Block

Context: The use of ultrasound in regional anaesthesia has resulted in reduction in local anaesthetic volume and adverse effects. Aim : This study aims to compare the quality of analgesia and incidence of adverse effects using two different volumes of 0.5 % bupivacaine for clavicular surgeries by ultrasound guided combined interscalene and superficial cervical plexus block. Settings and Design: randomized controlled double blinded interventional study Methods and Material: 60 patients undergoing clavicular surgery were randomized to receive ultrasound guided interscalene block of either 15 ml (group L) or 25 ml (Group H) of 0.5 % bupivacaine and 10 ml of 0.25 % bupivacaine for superficial plexus block. Both the groups were assessed for quality of intraoperative and postoperative analgesia by sensory, motor block. Hemidiaphragmatic paresis was assessed by ultrasound guided diaphragmatic movement. Statistical analysis used: continuous variable by student's t test and non parametric data by fisher's exact test. Results: Adequacy of intraoperative anesthesia and analgesia was comparable in both the groups (p – 1.00). Phrenic nerve palsy was present in 6 patients of group H whereas none of the patients of group L developed phrenic nerve palsy (p – 0.023). There were no requirement of supplementation of analgesics in both the groups intraoperatively. The duration of postoperative analgesia was 5.78 0.4 in group L and 5.7 0.4 in group H (p -0.459). Conclusions: Comparable quality of intraoperative and postoperative analgesia and reduced incidence of hemidiaphragmatic paresis can be obtained with 15 ml of 0.5 % bupivacaine compared to 25 ml of 0.5 % bupivacaine given by ultrasound guided combined interscalene and superficial cervical plexus block for clavicular surgeries. Key-words: brachial plexus, bupivacaine, interscalene, superficial cervical plexus, ultrasound Key Messages: ultrasound guided combined interscalene and superficial cervical plexus block reduce volume needed for adequate analgesia and adverse incidences associated with it.