Interscalene brachial plexus block : a comparative study between nerve stimulator and ultrasound guidance in shoulder surgery

Abstract EN

Background and objectives Ultrasonography seems to be the most suitable image modality for regional anesthesia.

Perhaps the most significant advantage of ultrasound technology is the ability to provide an anatomic examination of the area of interest in real time, which allows one to visualize the neural and the surrounding structures and visualize the pattern of local anesthetic spread.

The aim of this study was to evaluate ultrasound-guided nerve detection in an interscalene brachial plexus block and to compare it with nerve stimulator-guided nerve detection in terms of simplicity, safety, and efficacy.

Materials and methods Sixty patients were scheduled for unilateral shoulder surgery, shoulder arthroscopy, or surgical neck humerus surgery.

They were randomly divided into two groups (30 patients in each group): group I: those patients who received an interscalene brachial plexus block through ultrasound guidance and group II: those patients who received an interscalene brachial plexus block through nerve stimulator guidance.

Results The time required to perform the procedure was significantly less in group I = 5 (1) min compared with group II= 6.2 (1.3) min.

The block was successful in all patients of group I whereas two patients in the nerve stimulator group (group II) failed to achieve complete surgical block but the patients were excluded from the study.

This failure was statistically not significant.

Morphine consumption was statistically lower in group I 4 (1) mg/24 h than in group II 7 (1) mg/24 h.

Undesirable events were not observed among patients in group I, whereas three patients of group II (10%) had a complicated course such as delayed paresthesia, dyspnea, tinnitus, and circumoral numbness, but the difference between both the groups was not statistically significant (P40.05).

The degree of satisfaction showed a significant difference, favoring ultrasound guidance (group I) (86.6%) compared with group II (53.3%).

Conclusion An ultrasound-guided interscalene block offers shorter time, faster onset, prolonged duration of analgesia, more patient satisfaction, and less morphine consumption for postoperative analgesia, with no significant differences in terms of the success rate and complications, in comparison with the nerve stimulator-guided interscalene block