“Standard” Versus “Lower” Approach Interscalene Brachial Plexus Block for Upper Extremity Surgery: A Comparative Study
Journal Title: MedPulse -International Medical Journal - Year 2014, Vol 1, Issue 1
Abstract
Abstract: Aims and Objectives: To study and compare the “standard” and “lower” approach interscalene block in terms of- Time required performing the block, success rate, onset and duration of sensory and motor block and Complications if any. Results: We observed that, success rate of “lower” approach was 90% versus “standard” approach which has success rate of only 74%. “Lower” approach required lesser time (6.78 ± 2.64 mins. (Mean ± S.D.)) to perform the block compared to “standard” approach which required 10.06 ± 2.44 mins. (mean ±S.D). When we compared the two approaches in terms of onset of sensory block for axillary, musculocutaneous, radial, median, and ulnar nerves, we found no significant difference except ulnar nerve which showed significant difference (p<0.05). Ulnar sparing was more (17.8%) in “standard” approach as compared to (2.1%) of “lower” approach. There was no significant difference (p>0.05) for onset and duration of motor block as well as duration of sensory block. Rate of occurrence of complications was more for “standard” approach (Horner syndrome-50%, Recurrent Laryngeal nerve palsy-22%, Hemidiphragmatic palsy-30%) as compared to “lower” approach in which only 2% patients developed Horner’s syndrome. Conclusion: Lower approach interscalene brachial plexus block can be safely used for surgeries of upper extremity with advantages like lesser time required to perform the block, with higher success rate, lesser sparing of ulnar nerve and negligible complications. Thus lower approach interscalene brachial plexus block is superior to standard approaches of interscalene block as well as general anesthesia.
Authors and Affiliations
Manisha Surwade, Ganesh Nikam, V. S. Sirsat, A. S. Tarkase, Sadhana Kulkarni
Keywords
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