Supraclavicular Brachial Plexus Block for Upper Limb Fracture Fixation:A Comparison of Nerve Stimulation, Ultrasound-Guided Technique and a Combination of both Techniques.

BACKGROUND: Nerve stimulation and ultrasound-guided techniques for supraclavicular block have been widely studied but information on the effectiveness of the combination of both techniques is limited. AIMS AND OBJECTIVES: This study compared the success rate and block characteristics of 3 techniques for supraclavicular brachial plexus block. DESIGN: Prospective randomized control trial. SETTING: In a tertiary teaching hospital in which patients scheduled for upper limb surgeries were recruited. MATERIALS AND METHODS: Sixty-six eligible patients were randomized into nerve stimulation, ultrasound-guided technique and their combination groups. Each received 40 ml of equal volumes of 0.5% plain bupivacaine and 2% lidocaine with 1:200,000 adrenaline. The primary outcome was the success rate of block and secondary outcomes included block characteristics. Data were subjected to statistical analysis (2-tailed tests), p-value < 0.05 significant. RESULTS: Seventy subjects were recruited, 66 completed the study. The success rates include: Ultrasound-guided technique + Nerve Stimulator (100%), Ultrasound-guided technique (90.9) and Nerve stimulator (81.8%). The onset of motor block was faster in the ultrasound guided technique (p = 0.043). The quality of sensory block and full motor block was superior in the combination group at 10th and 15th minute respectively. There were no complications and patient satisfaction with care was comparable in the groups. CONCLUSION: This study shows that combining ultrasound-guided technique and nerve stimulator resulted in the highest success rate, better sensory and motor block within 15minutes at C8 dermatome. Thus, hand surgeries can commence early, minimizing waiting time.