Is ultrasound guidance superior to conventional nerve stimulation for coracoid infraclavicular brachial plexus block?
OBJECTIVE
In different peripheral nerve blocks, it has been speculated that needle guidance by ultrasound improves onset time and success rate compared with the more frequently used nerve stimulation-guided technique. In the present study, we tested the hypothesis that ultrasound guidance improves onset time of coracoid infraclavicular brachial plexus block (IBPB) when compared with a nerve stimulation-guided technique.


METHODS
Seventy patients scheduled for hand or forearm surgery were randomly assigned to receive coracoid IBPB using either ultrasound guidance (group U, n = 35), or nerve stimulation (group S, n = 35). Patients were assessed for sensory and motor block every 5 mins after injection of local anesthetic. Onset time, the primary end point, was defined as the time required for complete sensory and motor block. Time required to perform the block, success rate, and time to resolution of motor blockade were also recorded (secondary end points).


RESULTS
Onset of complete sensory and motor blockade was similar in the 2 groups (17 mins [8 mins] in group U and 19 mins [8 mins] in group S; P = 0.321). Time required to perform the block was shorter in group U (3 mins [1 min]) as compared with group S (6 mins [2 mins]; P < 0.0001). No differences were observed in success rate (89% in group U and 91% in group S; P = 0.881) and time to resolution of motor blockade (237 mins [45 mins] in group U and 247 mins [57 mins] in group S; P = 0.418).


CONCLUSIONS
The present investigation demonstrates that ultrasound guidance and nerve stimulation provide similar onset time, success rate, and duration of motor blockade for coracoid IBPB; however, ultrasound guidance reduces the time required to perform the block.
Taboada
Manuel
M
Department of Anesthesiology, Hospital Clínico Universitario de Santiago, Travesíada Choupana s/n, Santiago de Compostela 15706, Spain. manutabo@yahoo.es
Rodríguez
Jaime
J
Amor
Marcos
M
Sabaté
Sergi
S
Alvarez
Julian
J
Cortés
Joaquín
J
Atanassoff
Peter G
PG
D001917:Brachial Plexus; D002968:Clavicle; D005260:Female; D005542:Forearm / Q000601:surgery; D006225:Hand / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D011677:Punctures / Q000379:methods; D016037:Single-Blind Method; D013997:Time Factors; D004561:Transcutaneous Electric Nerve Stimulation / Q000295:instrumentation* / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods*; D014953:Wrist / Q000601:surgery