There are several well-established techniques for performing peripheral nerve blocks including paresthesia, nerve stimulation and by using ultrasound. Those advocating the use of nerve stimulators claim that apart from a comparable success rate and shorter time for block placement this technique may be performed on heavily sedated or anesthetized patients and even in a patient who is not so cooperative since it provides exact needle localization without the elicitation of a paresthesia. However this technique needs skills, knowledge and expertise by routinely doing it. This study compared the success rate of classical supraclavicular approach of Brachial plexus block given with the aid of a nerve stimulator and nerve stimulator along with ultrasound. Eighty patients were randomized into two groups of forty each. In group 1, brachial plexus block was given by nerve stimulation and in group 2 with the aid of an Ultrasound along with nerve stimulation. The success rate of block was more in ultrasound group than nerve stimulation group though not statistically significant. There was completeness of the block of in 90 % of patients in group 2 and 75% of patients in group 1. The mean time taken for performance of block/time taken for the procedure was 10.375 min in group 1 while in group 2it was significantly shorter (6.25mins).Onset of sensory and motor blockade was shorter in ultrasound group than in nerve stimulation group. Duration of analgesia was longer in group US and it was statistically significant. It was also noted that there was no incidence of vessel punctures, nerve injuries and pneumothorax in the ultrasound group. In conclusion, ultrasound guided technique is safe and effective means of performing peripheral nerve blockade with a comparable success rate.

Keywords: peripheral nerve blocks, paresthesia, supraclavicular, Brachial plexus, nerve stimulator, ultrasound.

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Dr P Rajeswar

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