A Comparative Study between Anatomical Landmark and Nerve Stimulator Guided Supraclavicular Brachial Plexus Block for Neurovascular Variations in Topographic Anatomy of Brachial Plexus

A comparative study between anatomical landmark and nerve stimulator guided supraclavicular brachial plexus block for neurovascular variations in topographic anatomy of brachial plexus. In the backdrop of our country, nerve stimulator is still not available in many centres and many anesthetists do not yet have the proper expertise and experience in giving nerve stimulator guided brachial plexus blocks as compared to their performance of anatomical landmark guided brachial plexus block. Study revealed that anatomical landmark guided brachial plexus block is as good a method as the nerve stimulator guided technique and there is no added advantage that the nerve stimulator guided method will have over it. However , supraclavicular brachial plexus block for neurovascular variations in topographic anatomy may not be benefited from the performance of anatomical landmark guided block as literature revealed no specific established neurovascular variation in topographic anatomy in respect to age sex, race, body weight in living subjects.. No anatomical variation in the brachial plexuses under study could be found out since direct visualisation of the brachial plexus was not possible from either of the methods.. The aim was to compare between percentage of patients successfully completing the surgical procedure using anatomical landmark guided supraclavicular brachial plexus blocks versus nerve stimulator guided supraclavicular brachial plexus blocks in order to delineate the anatomical variation of brachial plexus. In this prospective, randomised, open level parallel group study and onset of sensory blockade was judged by pin-prick, temperature testing, motor blockade--by ’push, pull, pinch, pinch’. Percentage of patients successfully completing the surgical procedure using anatomical landmark guided supraclavicular brachial plexus blocks versus nerve stimulator guided supraclavicular brachial plexus blocks were determined . Incidence of failure of block were noted in both the methods . All the results were statistically analysed. Success rate of patients underwent supraclavicular brachial plexus block , taking the number of patients completing operation without conversion to general anaesthesia as the parameter, is 80.39 % in patients given anatomical landmark guided supraclavicular brachial plexus block and 78.43 % in patients given nerve stimulator guided supraclavicular brachial plexus block .Thus in patients with anatomical variations of brachial plexus , identification of surface landmarks for the purpose of giving blocks is not fruitful. It was concluded that the anatomical methods are not a reliable technique. Direct visualization of the brachial plexus by newer methods is needed for 100% success .