Comparative Evaluation of Techniques in Supraclavicular Brachial Plexus Block: Conventional Blind, Nerve Stimulator Guided, and Ultrasound Guided

Introduction: In recent years, real-time ultrasonographic guidance has been introduced for peripheral nerve blocks, which is rapidly evolving and becoming increasingly more useful in the field of regional anesthesia. Objective: The aim of this study was to compare the three techniques of brachial plexus block. Trial design: This was a prospective, randomized clinical trial. Materials and Methods: About ninety patients of either sex, aged 18–60 years, ASA physical status I and II, and posted for elective surgery of upper limb were included. Brachial plexus was blocked by conventional blind in Group I (CB), Group II nerve stimulator (NS) technique whereas Group III by ultrasound (US)-guided technique. All the three groups were injected 2% xylocaine with adrenaline 1:200,000 in a dose of 7 mg/kg body weight. The drug solution was diluted with normal saline to make a final concentration of 1.5%. Results: Comparison of blockade characteristics between the CB, NS, and US-guided groups revealed that the procedural time and number of skin puncture were nonsignificant in all the three groups. The onset of sensory and motor blockade was significantly less in US group compared to other groups. The mean duration of analgesia was significantly higher in both NS and US groups compared to CB group. The incidence of patchy effect and blockade failure requiring general anesthesia was significantly higher in CB group (13.3%) compared to NS group (10%) and US group (3.3%). Conclusion: The success rate and effective quality of the block were more satisfactory with US technique than the NS or CB technique. The onset time of sensory and motor blockade was significantly less in US group, while the incidence of complications such as vessel puncture was seen only in CB group.