ULTRASOUND-GUIDED SUPRACLAVICULAR APPROACH FOR REGIONAL ANESTHESIA OFTHE BRACHIAL-PLEXUS

We prospectively studied 40 patients (ASA grades I-III) undergoing sur gery of the forearm and hand, to investigate the use of ultrasonic can nula guidance for supraclavicular brachial plexus block and its effect on success rate and frequency of complications. Patients were randomi zed into Group S (supraclavicular paravascular approach; n = 20) and G roup A (axillary approach; n = 20). Ultrasonographic study of the plex us sheath was done. After visualization of the anatomy, the plexus she ath was penetrated using a 24-gauge cannula. Plexus block was performe d using 30 mL bupivacaine 0.5%. Onset of sensory and motor block of th e radial, ulnar, and median nerves was recorded in 10-min intervals fo r 1 h. Satisfactory surgical anesthesia was attained in 95% of both gr oups. In Group A, 25% showed an incomplete sensory block of the muscul ocutaneous nerve, whereas all patients in Group S had a block of this nerve. Complete sensory block of the radial, median, and ulnar nerves was attained after an average of 40 min without a significant differen ce between the two groups. Because of the direct ultrasonic view of th e cervical pleura, we had no cases of pneumothorax. An accidental punc ture of subclavian or axillary vessels, as well as neurologic damage, was avoided in all cases. An ultrasonography-guided approach for supra clavicular block combines the safety of axillary block with the larger extent of block of the supraclavicular approach.