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Ultrasonographic Guidance Reduces the Amount of Local Anesthetic for 3-in-1 Blocks
  1. Peter Marhofer, M.D.,
  2. Klaus Schrögendorfer, M.D.,
  3. Thomas Wallner, M.D.,
  4. Herbert Koinig, M.D.,
  5. Nikolaus Mayer, M.D. and
  6. Stefan Kapral, M.D.
  1. From the Department of Anesthesiology and General Intensive Care Medicine, University of Vienna, School of Medicine, Vienna, Austria.
  1. Reprint requests: Peter Marhofer, M.D., Department of Anesthesiology and General Intensive Care Medicine, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.

Abstract

Background and Objectives Recently it has been demonstrated that the use of ultrasound (US) improves the onset time and the quality of sensory block for 3-in-1 blocks compared with conventional nerve stimulator (NS) techniques. The present study was designed to evaluate if US guidance for 3-in-1 blocks reduces the amount of local anesthetic compared to NS guidance.

Methods After institutional approval and informed consent, 60 patients undergoing hip surgery following trauma were randomly assigned to three groups of 20 patients each. In group A, the 3-in-1 block was performed using US guidance with 20 mL 0.5% bupivacaine. Group B received 20 mL 0.5% bupivacaine, and group C received 30 mL 0.5% bupivacaine during NS guidance. The quality and the onset time was assessed by pinprick test in the central sensory region of each of the three targeted nerves and compared with the contralateral leg every 10 minutes for 1 hour by a blinded observer. The rating was undertaken using a scale from 100% (uncompromised sensibility) to 0% (no sensation).

Results Overall success for the 3-in-1 block in group A was 95% and in groups B and C 80%. Onset time was significantly shorter in the US-guided group compared with both NS-guided groups (group A 13 ± 6 minutes; group B 27 ± 12 minutes; and group C 26 ± 13 minutes; P < .01 to groups B and C). Quality of sensory block was significantly better in group A (4% ± 5% of initial value) compared with groups B and C (group B 21% ± 11% of initial value, P < .01 to group A; group C 22% ± 19%, P < .01 to group A).

Conclusion The amount of local anesthetic for 3-in-1 blocks can be reduced by using US guidance compared with the conventional NS-guided technique.

  • 3-in-1 block
  • ultrasound
  • nerve stimulator
  • bupivacaine

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Footnotes

  • This study was performed at the Department of Anesthesiology and General Intensive Care Medicine, University of Vienna, 18-20 Waehringer Guertel, A-Vienna, Austria.

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