title: Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks.
abstract: The use of ultrasound reduces the onset time, improves the quality of sensory block, and minimizes the risks associated with the supraclavicular approach for brachial plexus and stellate ganglion blockade. The present study was designed to evaluate whether ultrasound also facilitates the approach for 3-in-1 blocks. Forty patients (ASA physical status II or III) undergoing hip surgery after trauma were randomly assigned to two groups. In the ultrasound (US) group, 20 mL bupivacaine 0.5% was administered under US guidance, whereas in the control group, the same amount and concentration of local anesthetic was administered with the assistance of a nerve stimulator (NS). After US- or NS-based identification of the femoral nerve, the local anesthetic solution was administered, and the distribution of the local anesthetic solution was visualized and recorded on videotape in the US group. The quality and the onset of the sensory block was assessed by using the pinprick test in the central sensory region of each of the three nerves and compared with the same stimulation on the contralateral leg every 10 min for 60 min. The rating was performed using a scale from 100% (uncompromised sensibility) to 0% (no sensory sensation). Heart rate, noninvasive blood pressure, and oxygen saturation were measured at short intervals for 60 min. The onset of sensory blockade was significantly shorter in Group US compared with Group NS (US 16 +/- 14 min, NS 27 +/- 16 min, P < 0.05). The quality of the sensory block after injection of the local anesthetic was also significantly better in Group US compared with Group NS (US 15% +/- 10% of initial value, NS 27% +/- 14% of initial value, P < 0.05). A good analgesic effect was achieved in 95% of the patients in the US group and in 85% of the patients in the NS group. In the US group, visualization of the cannula tip, the femoral nerve, the major vessels, and the local anesthetic spread was possible in 85% of patients. Incidental arterial puncture (n = 3) was observed only in the NS group. We conclude that an US-guided approach for 3-in-1 block reduces the onset time, improves the quality of the sensory block and minimizes the risks associated with this regional anesthetic technique.
  
  
  CONCLUSIONS
  The onset time and the quality of a regional anesthetic technique for the lower extremity is improved by ultrasonographic nerve identification compared with older techniques.
authors.affiliation: Department of Anesthesiology and General Intensive Care Medicine, University of Vienna, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Marhofer
authors.forename: K
authors.initials: K
authors.lastname: Schrögendorfer
authors.forename: H
authors.initials: H
authors.lastname: Koinig
authors.forename: S
authors.initials: S
authors.lastname: Kapral
authors.forename: C
authors.initials: C
authors.lastname: Weinstabl
authors.forename: N
authors.initials: N
authors.lastname: Mayer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008875:Middle Aged; D009407:Nerve Block; D012677:Sensation; D013997:Time Factors; D014463:Ultrasonography