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Double-injection technique assisted by a nerve stimulator for ultrasound-guided supraclavicular brachial plexus block results in better distal sensory-motor block: A randomised controlled trial.
Eur J Anaesthesiol. 2017 03; 34(3):127-134.EJ

Abstract

BACKGROUND

To evaluate the efficacy of a nerve stimulator when used with ultrasound-guided double injection in supraclavicular brachial plexus block.

OBJECTIVES

We hypothesised that targeting the inferior trunk of the plexus guided by a nerve stimulator would obtain a higher success rate of ulnar nerve blockade than the traditional double-injection technique.

DESIGN

A blinded randomised controlled study.

SETTING

Conducted at the University Hospital from October 2015 to January 2016.

PATIENTS

Ninety patients undergoing upper extremity surgery were randomised into two equal groups.

INTERVENTIONS

Patients were randomly allocated to a modified double-injection group (MDI group) or a traditional double-injection group (DI group). All patients received 23 ml of a 1 : 1 mixture of 2% lidocaine and 1% ropivacaine during ultrasound-guided supraclavicular brachial plexus block. In the MDI group (n = 45), half the volume was deposited within the brachial plexus sheath guided by ultrasound, next to the inferior trunk and verified by nerve stimulation; the remaining volume was deposited in the main neural cluster. In the double-injection group (n = 45), the first half volume was deposited on ultrasound guidance alone. Sensory-motor blockade of the musculocutaneous, median, radial, ulnar nerves and surgical anaesthesia, performance time, number of needle passes and complications were recorded.

MAIN OUTCOME MEASURES

The success rate of complete sensory block of the ulnar nerve within 15 min after local anaesthetic injection.

RESULTS

Compared with the DI group the MDI group had higher success rates of complete sensory block of the ulnar nerve (93 vs 67%, P = 0.002) and complete anaesthesia (80 vs 56%, P = 0.014) at 15 min, whereas the average performance time was significantly longer (5.08 ± 1.41 vs 4.10 ± 0.64 min, P < 0.001) and the number of needle passes was significantly higher (4.40 ± 1.14 vs 2.87 ± 0.79, P < 0.001).

CONCLUSION

The MDI technique has a higher success rate for complete sensory block of the ulnar nerve within 15 min of local anaesthetic injection. The time needed to perform the block is about 1 min longer than the traditional technique.

TRIAL REGISTRATION

http://www.chictr.org.cn with the registration number of ChiCTR-IOR-15007588.

Authors+Show Affiliations

From the Department of Anesthesiology, Guangdong Second Provincial People's Hospital (QL, HHS); Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (WY); and Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine (QL, MZ).No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27798452

Citation

Luo, Quehua, et al. "Double-injection Technique Assisted By a Nerve Stimulator for Ultrasound-guided Supraclavicular Brachial Plexus Block Results in Better Distal Sensory-motor Block: a Randomised Controlled Trial." European Journal of Anaesthesiology, vol. 34, no. 3, 2017, pp. 127-134.
Luo Q, Yao W, Shu H, et al. Double-injection technique assisted by a nerve stimulator for ultrasound-guided supraclavicular brachial plexus block results in better distal sensory-motor block: A randomised controlled trial. Eur J Anaesthesiol. 2017;34(3):127-134.
Luo, Q., Yao, W., Shu, H., & Zhong, M. (2017). Double-injection technique assisted by a nerve stimulator for ultrasound-guided supraclavicular brachial plexus block results in better distal sensory-motor block: A randomised controlled trial. European Journal of Anaesthesiology, 34(3), 127-134. https://doi.org/10.1097/EJA.0000000000000542
Luo Q, et al. Double-injection Technique Assisted By a Nerve Stimulator for Ultrasound-guided Supraclavicular Brachial Plexus Block Results in Better Distal Sensory-motor Block: a Randomised Controlled Trial. Eur J Anaesthesiol. 2017;34(3):127-134. PubMed PMID: 27798452.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Double-injection technique assisted by a nerve stimulator for ultrasound-guided supraclavicular brachial plexus block results in better distal sensory-motor block: A randomised controlled trial. AU - Luo,Quehua, AU - Yao,Weifeng, AU - Shu,HaiHua, AU - Zhong,Ming, PY - 2016/11/1/pubmed PY - 2018/9/25/medline PY - 2016/11/1/entrez SP - 127 EP - 134 JF - European journal of anaesthesiology JO - Eur J Anaesthesiol VL - 34 IS - 3 N2 - BACKGROUND: To evaluate the efficacy of a nerve stimulator when used with ultrasound-guided double injection in supraclavicular brachial plexus block. OBJECTIVES: We hypothesised that targeting the inferior trunk of the plexus guided by a nerve stimulator would obtain a higher success rate of ulnar nerve blockade than the traditional double-injection technique. DESIGN: A blinded randomised controlled study. SETTING: Conducted at the University Hospital from October 2015 to January 2016. PATIENTS: Ninety patients undergoing upper extremity surgery were randomised into two equal groups. INTERVENTIONS: Patients were randomly allocated to a modified double-injection group (MDI group) or a traditional double-injection group (DI group). All patients received 23 ml of a 1 : 1 mixture of 2% lidocaine and 1% ropivacaine during ultrasound-guided supraclavicular brachial plexus block. In the MDI group (n = 45), half the volume was deposited within the brachial plexus sheath guided by ultrasound, next to the inferior trunk and verified by nerve stimulation; the remaining volume was deposited in the main neural cluster. In the double-injection group (n = 45), the first half volume was deposited on ultrasound guidance alone. Sensory-motor blockade of the musculocutaneous, median, radial, ulnar nerves and surgical anaesthesia, performance time, number of needle passes and complications were recorded. MAIN OUTCOME MEASURES: The success rate of complete sensory block of the ulnar nerve within 15 min after local anaesthetic injection. RESULTS: Compared with the DI group the MDI group had higher success rates of complete sensory block of the ulnar nerve (93 vs 67%, P = 0.002) and complete anaesthesia (80 vs 56%, P = 0.014) at 15 min, whereas the average performance time was significantly longer (5.08 ± 1.41 vs 4.10 ± 0.64 min, P < 0.001) and the number of needle passes was significantly higher (4.40 ± 1.14 vs 2.87 ± 0.79, P < 0.001). CONCLUSION: The MDI technique has a higher success rate for complete sensory block of the ulnar nerve within 15 min of local anaesthetic injection. The time needed to perform the block is about 1 min longer than the traditional technique. TRIAL REGISTRATION: http://www.chictr.org.cn with the registration number of ChiCTR-IOR-15007588. SN - 1365-2346 UR - https://www.unboundmedicine.com/medline/citation/27798452/Double_injection_technique_assisted_by_a_nerve_stimulator_for_ultrasound_guided_supraclavicular_brachial_plexus_block_results_in_better_distal_sensory_motor_block:_A_randomised_controlled_trial_ L2 - https://doi.org/10.1097/EJA.0000000000000542 DB - PRIME DP - Unbound Medicine ER -