title: Electrostimulation with or without ultrasound-guidance in interscalene brachial plexus block for shoulder surgery.
abstract: In a prospective controlled trial to compare conventional interscalene brachial plexus block (ISBPB) using anatomic landmarks and electro-stimulation with a combined technique of ultrasound guidance followed by nerve stimulation, 60 patients were randomized into 2 matched equal groups: Group A using nerve stimulation (NS) alone and Group B using the combination of ultrasound and NS. The time to detect the plexus (3.9 ± 4 min in Group A and 3.3 ± 1.4 min in Group B) was not significantly different. We needed to reposition the needle once (n = 13) or twice (n = 4) in Group B. First-shot motor response was achieved in all but one patient in Group A; here we were only able to locate the plexus by use of ultrasound. None of the patients needed general anaesthesia. There were no significant differences between postoperative pain, motor power, or patient's satisfaction. ISBPB seems similarly effective using electro-stimulation and ultrasound if performed by experienced anesthesiologists.
authors.affiliation: Department of Anaesthesiology, Intensive Medicine and Pain Therapy, Ulm University and Rehabilitation Hospital (RKU), Oberer Eselsberg 45, 89081, Ulm, Germany.
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Salem
authors.forename: Jörg
authors.initials: J
authors.lastname: Winckelmann
authors.forename: Peter
authors.initials: P
authors.lastname: Geiger
authors.forename: Hans-Hinrich
authors.initials: HH
authors.lastname: Mehrkens
authors.forename: Khaled H
authors.initials: KH
authors.lastname: Salem
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia; D000779:Anesthetics, Local / Q000008:administration & dosage; D001917:Brachial Plexus / Q000000981:diagnostic imaging* / Q000502:physiology*; D016292:Procedural Sedation; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology; D009407:Nerve Block / Q000379:methods*; D019637:Orthopedic Procedures; D015742:Propofol; D011446:Prospective Studies; D012782:Shoulder / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol