title: THE EFFECT OF COMBINING AXILLARY BRACHIAL PLEXUS BLOCK WITH INTERSCALENE OR SUPRACLAVICULAR BLOCK FOR UPPER LIMB SURGERIES USING NEUROSTIMULATION TECHNIQUE.
abstract: BACKGROUND
  The different approaches to the brachial plexus have clinical implications and all these approaches have clinical limitations. Combining different approaches helps to reduce these limitations. Can a combination of two different methods of brachial plexus block give a better anaesthetic outcome?
  
  
  OBJECTIVE
  To compare the effect of combining axillary plexus block with interscalene as opposed to axillary plexus block with supraclavicular blocks.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  University of Benin Teaching Hospital, Benin city. Edo state. Nigeria.
  
  
  METHODS
  A total of 182 patients who met the inclusion criteria were observed and were divided into 5 groups. Group I (interscalene) n=33, Group S (supraclavicular) n=39, Group A (axillary) n=35. Group IA (interscalene and axillary) n=34, Group SA (supraclavicular and axillary) n=41. The brachial plexus was identified using a nerve stimulator and 40ml of 2% lidocaine with 1:200,000 adrenaline and 0.5% bupivacaine, were deposited in each single approach or divided into two equal portions in the combined approach .The time of onset, duration of analgesia, level of satisfaction and complications were compared.
  
  
  RESULTS
  There were no differences with regard to the time of onset (p= 0.74), duration of analgesia (p= 0.82), patients' satisfaction between the groups. Horner's syndrome was a commonest complication in the interscalene group consisting (15.15%) cases.
  
  
  CONCLUSIONS
  There was no difference in terms of time of onset, duration of sensory block and level of patients' satisfaction between the combined brachial plexus approaches and single approach.
authors.affiliation: Department of Anaesthesiology, University of Benin Teaching Hospital, Benin City, Nigeria.
authors.forename: H O
authors.initials: HO
authors.lastname: Idehen
authors.affiliation: Department of Anaesthesiology, University of Benin Teaching Hospital, Benin City, Nigeria.
authors.forename: C A
authors.initials: CA
authors.lastname: Imarengiaye
keywords: Brachial plexus block; Combination options; Neurostimulation; Outcome