A Randomized Comparison Between Two Injections from Two Planes versus Two Injections with a Uniplanar Approach for Ultrasound-Guided Supraclavicular Block
- Authors
- Lee, Ji Yeon; Park, Hee Yeon; Choi, Yun Suk; Chang, Young Jin; Shin, Hyeon Ju; Lee, Mi Geum
- Issue Date
- Jan-2021
- Publisher
- American Society of Interventional Pain Physicians
- Keywords
- Brachial plexus block; multiple injection; supraclavicular block; ultrasound
- Citation
- Pain Physician, v.24, no.1, pp.e15 - e21
- Journal Title
- Pain Physician
- Volume
- 24
- Number
- 1
- Start Page
- e15
- End Page
- e21
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/79742
- ISSN
- 1533-3159
- Abstract
- BACKGROUND: The brachial plexus courses along the lateral to posterior aspect of the subclavian artery located within the supraclavicular region as a trunk or division. Therefore we hypothesized that 2 injections, one along the lateral and one along the posterior aspect of the brachial plexus, could be performed by changing the angle of the ultrasound probe, thereby achieving a 3-dimensional (3-D) even distribution of local anesthetics. Previously, we confirmed the efficacy of this type of approach with that of a single cluster approach. These findings represent a subsequent study.
OBJECTIVES: This study was conducted to confirm the superiority of block quality achieved by 2 injections from 2 planes (control group; group C) over 2 injections in one plane (experimental group; group E).
STUDY DESIGN: A randomized, controlled trial.
SETTING: Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center.
METHODS: In group C (n = 35), the brachial plexus sheath was penetrated in 2 planes by anteriorly altering the angle of the ultrasound probe without changing its position. In group E (n = 35), the upper and lower portions of the brachial plexus sheath were penetrated in one plane. A total of 15 mL of lidocaine 1.5% containing epinephrine (1:200,000) was injected at each point in both groups. The ultrasound-guided supraclavicular brachial plexus block was evaluated every 5 minutes for 30 minutes. The main outcome variables were rates of blockage of all 4 nerves and ulnar nerve sparing.
RESULTS: The rate of blockage of all 4 nerves (median, ulnar, radial, and musculocutaneous nerves) was not significantly different between the 2 groups (94% in group C vs. 86% in group E, respectively; P = 0.232). The number of spared ulnar nerves was similar (1 vs. 5, respectively; P = 0.088). Group procedure times, onset times, and Visual Analog Scale scores for the blocks were similar.
LIMITATIONS: For the 2 plane, 2 injection approach, only 2-D imaging was performed rather than 3-D imaging.
CONCLUSIONS: Two injections performed in one plane offered similar benefits to 2 injections performed in 2 planes. The 2 techniques provided comparable block qualities and could be viewed as equally effective alternatives.
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