Ultrasound-Guided Supraclavicular Brachial Plexus Block in Hand and Forearm Surgery: Case Series

Dujduen Sriramatr MD1, Wanida Chongarunngamsang MD1, Chaiyapruk Kusumaphanyo MD1, Junjira Promma RN1

Affiliation : 1 Department of Anesthesiology, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhon Nayok, Thailand

Objective : Paresthesia technique or nerve stimulator-guided supraclavicular brachial plexus block can cause nerve injury, patient’s discomfort, and dissatisfaction during the procedure. The present study aimed to retrospectively review the practice of ultrasound- guided supraclavicular brachial plexus block for orthopedic hand and forearm surgery.
Materials and Methods : Medical records of 175 patients receiving ultrasound-guided supraclavicular brachial plexus block for hand and forearm surgery, between January 2013 and December 2015, were retrospectively reviewed. The anatomical sonography of supraclavicular area was imaged by 2-D linear probe. The needle was advanced by in-plane technique and lateral to median direction. Multiple sites injection was needed depending on the visibility of spreading of local anesthetic agent. Complete block, block with intravenous opioids supplement, and block with additional ulnar nerve block were de(cid:976)ined as successful block. Failed block was de(cid:976)ined as the conversion to general anesthesia.
Results : Brachial plexus block in 170 patients (97.14%) were successful whereas (cid:976)ive patients (2.86%) were converted to general anesthesia with laryngeal mask airway. There was no serious complication such as pneumothorax or intravascular injection.
Conclusion : Ultrasound-guided supraclavicular brachial plexus block with linear probe and in-plane needle advancement provided high success rate and low complication.

Keywords : Supraclavicular brachial block, Ultrasound guided regional block, Complication

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