Brachial plexus blockade for emergency surgery: a comparison of three techniques for plexus approach.

Objectives: To compare three techniques of brachial plexus blockade for eme rgency surgery of the upper limb. Study design: Prospective, randomised study. Patients: One hundred eleven patients admitted to an emergency surgical ser vice, randomly assigned to three groups. Methods: The patients were given 2% lidocaine with epinephrine 20 mt and 0. 5% bupivacaine 20 mt, The three groups were as follows: brachial plexus blo ck using a peripheral nerve stimulator (group St, n = 38); transarterial br achial plexus blockade with injection of 2/3 of the anaesthetic in back of and 1/3 in front of the artery (group TAP, n = 36); transarterial brachial plexus blockade with one single injection in back of the artery (group TP, n = 37), The success rate, time required to perform the technique, latency of analgesia, quality of motor blockade, and adverse effects were compared between the three groups. Analysis of variance was used to compare quantita tive data and chi(2) test were used for qualitative data. Results: Rates of success varied between 65 and 75%. Success rates, latency of analgesia and quality of motor blockade were not significantly differen t between groups. Time to perform the technique was longer when using a ner ve stimulator. Conclusion: As these three techniques for brachial plexus block in emergenc y surgery are comparable, no one can be recommended instead of the others. (C) 1998 Elsevier, Paris.