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Abstract
Background and Aims Ultrasound (US) has become standardized during peripheral nerve block (PNB). Peripheral nerve stimulator (PNS) is combined with US to avoid intraneural injection (1). Monitoring opening injection pressure with a sensor could also show intraneural injection (2). Adding PNS to US guidance did not change block success rates for different types of PNBs (3,4). There is no study in the literature that evaluate effectiveness of adding PNS to US for a successful costaclavicular brachial plexus block (CCBPB). In this randomized prospective clinical study US and injection pressure monitor (IPM) guided CCBPB is compared with US, IPM and PNS guided CCBPB.
Methods 60 patients scheduled for orthopedic surgery below the elbow were enrolled in the study. Ultrasound and IPM guided group called USP and US, IPM and PNS guided group called USPN. In both groups 30 ml bupivacaine-lidocaine mixture was injected when injection pressure is less than 15 psi. In Group USPN, local anesthetic was injected after visualizing the disappearance of motor movement under 0.3 mA on PNS. Motor and sensorial block levels of the radial, ulnar, median and musculocutaneous nerves were measured. Block success rate, block performance time, number of needle passes and complication rates were compared.
Results Block success rate, number of needle passes and complications were similar (table 1). Block performance time was longer in group USPN (figure 1).
Conclusions Peripheral nerve stimulator is not necessary for a successful CCBPB. Using PNS increased block performance time significantly. Ultrasound and IPM are enough for a successful block with shorter procedure time in CCBPB.