CONVENTIONAL ANATOMICAL LANDMARK TECHNIQUE AND ITS COMPARISON WITH ULTRASOUND TECHNIQUE FOR SUPRACLAVICULAR BRACHIAL PLEXUS NERVE BLOCK IN PATIENTS UNDERGOING UPPER LIMB SURGERIES

Background: Brachial plexus blockade is a well known anesthetic technique for upper limb surgeries.The advantage with supraclavicular block is that it has a rapid action which is predictable and complete for the entire upper extremity.This technique is also called as spinal of upper limb. Earlier, the Landmark technique has been traditionally used for performing this block. But blind technique often requires multiple needle attempts, resulting in increase in procedure time, more patient discomfort and complications likepneumothorax. Ultrasound being a relatively new technique in our country is increasingly being used for performing nerve blocks for limb surgeries.

Objective:  This study was done to evaluate safety and comfort of ultrasound technology for supraclavicular brachial plexus blocks.

Methods: We included 60 adult patients of either sex undergoing surgeries for fracture of elbow region or fracture of the forearm bones. Patients were divided into two groups. In one group, anatomical landmark technique was used while in other group,supraclavicularnerve block was performed using ultrasound technique by double injection technique. All patients received 10 ml each of 1% lidocaine, 20 ml 0.5% Ropivacaine and 10 ml of saline. Surgery was started after confirming adequacy of block. Patients having ineffective blocks were excluded from the study and converted into general anaesthesia.

Results:  Supraclavicular plexus nerve block was placed in all 60 patients. Block failure was seen in 6 patients in landmark technique group and in twopatient in USG group. The time for onset of sensory and motor block was shorter in USG group than the landmark technique group. Intra-op addition of analgesic was required in 6patients in blind group and only 3 patients in USG group. The duration of post-op analgesia was more the in USG guided group as compared to blind group.

Conclusion: Ultrasound guidance is a clinical boon forsupraclavicular brachial plexus block.USG allows direct real time visualization of underlying structures and predictable spread of local anesthetic and therefore making the procedure faster and safer without much complications.