title: Comparison of two approaches to brachial plexus anesthesia for proximal upper extremity surgery: interscalene and intersternocleidomastoid.
abstract: We conducted a prospective, randomized study to compare differences between groups of patients given a brachial plexus block using an interscalene (IS) or an intersternocleidomastoid (ISCM) approach. Specific variables analyzed included overall success rates, time to achieve sensory and motor anesthesia, time to place block, and incidence of side effects. For the study, 81 patients were randomized to receive a brachial plexus blockade using the IS or ISCM approach followed by general anesthesia for their surgical procedure. Intraoperative analgesics were controlled for in both groups. No differences in demographics, block success rate, pain scale scores, and analgesia duration were noted between groups. The ISCM group required less time to complete the block (7.08 +/- 2.9 min) compared with the IS group (9.62 +/- 5.31 min) (P = .039), achieved a significantly higher rate of complete motor and sensory block at 30 minutes (P = .032), and had fewer side effects (P = .049). Based on our results, we found that using the ISCM approach to the brachial plexus resulted in a faster onset of anesthesia and a higher ratio of complete block at 30 minutes compared with the IS approach.
authors.affiliation: Naval Hospital, Camp Lejeune, NC, USA.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Dewees
authors.forename: Cary T
authors.initials: CT
authors.lastname: Schultz
authors.forename: Fred K
authors.initials: FK
authors.lastname: Wilkerson
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Kelly
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Biegner
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Pellegrini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D000779:Anesthetics, Local; D001132:Arm / Q000294:innervation / Q000601:surgery; D001917:Brachial Plexus; D006732:Horner Syndrome / Q000139:chemically induced; D006801:Humans; D007366:Intercostal Muscles; D008619:Mepivacaine; D008875:Middle Aged; D009334:Neck Muscles; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D017060:Patient Satisfaction; D011446:Prospective Studies; D012133:Respiratory Paralysis / Q000139:chemically induced; D016683:Supine Position; D013748:Tetracaine; D013997:Time Factors; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000139:chemically induced
chemical_list: D000779:Anesthetics, Local; D013748:Tetracaine; D008619:Mepivacaine