title: Comparison of peripheral nerve stimulator versus ultrasonography guided axillary block using multiple injection technique.
abstract: BACKGROUND
  The established methods of nerve location were based on either proper motor response on nerve stimulation (NS) or ultrasound guidance. In this prospective, randomised, observer-blinded study, we compared ultrasound guidance with NS for axillary brachial plexus block using 0.5% bupivacaine with the multiple injection techniques.
  
  
  METHODS
  A total of 120 patients receiving axillary brachial plexus block with 0.5% bupivacaine, using a multiple injection technique, were randomly allocated to receive either NS (group NS, n = 60), or ultrasound guidance (group US, n = 60) for nerve location. A blinded observer recorded the onset of sensory and motor blocks, skin punctures, needle redirections, procedure-related pain and patient satisfaction.
  
  
  RESULTS
  The median (range) number of skin punctures were 2 (2-4) in group US and 3 (2-5) in group NS (P < 0.001). No differences were observed in the onset of sensory block in group NS (6.17 ± 1.22 min) and in group US (6.33 ± 0.48 min) (P = 0.16), and in onset of motor block (23.33 ± 1.26 min) in group US and (23.17 ± 1.79 min) in group NS; P > =0.27). Insufficient block was observed in three patient (5%) of group US and four patients (6.67%) of group NS (P > =0.35). Patient acceptance was similarly good in the two groups.
  
  
  CONCLUSIONS
  Multiple injection axillary blocks with ultrasound guidance provided similar success rates and comparable incidence of complications as compared with NS guidance with 20 ml 0.5% bupivacaine.
authors.affiliation: Department of Anaesthesiology, 151 Base Hospital, Guwahati, Assam, India.
authors.forename: Alok
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Anaesthesiology, 151 Base Hospital, Guwahati, Assam, India.
authors.forename: Dk
authors.initials: D
authors.lastname: Sharma
authors.affiliation: Department of Radiodiagnosis and Imaging, 151 Base Hospital, Guwahati, Assam, India.
authors.forename: Maj E
authors.initials: ME
authors.lastname: Sibi
authors.affiliation: Department of Orthopaedic and Joint Replacement, 151 Base Hospital, Guwahati, Assam, India.
authors.forename: Barun
authors.initials: B
authors.lastname: Datta
authors.affiliation: Department of Orthopaedic and Joint Replacement, 151 Base Hospital, Guwahati, Assam, India.
authors.forename: Biraj
authors.initials: B
authors.lastname: Gogoi
keywords: Axillary block; multiple injection techniques; peripheral nerve stimulator