COMPARISON OF ELECTROSTIMULATION-GUIDED VERTICAL INFRACLAVICULAR BLOCK VERSUS TRANSARTERIAL AXILLARY BLOCK FOR UPPER LIMB ORTHOPEDIC SURGERY: A RANDOMIZED PROSPECTIVE CLINICAL STUDY

Dr. Indira Kumari*, Dr. Hemraj Tungaria, Dr. Lalatendu Swain, Dr. Vikram Bedi, Dr. Suman Sharma and Dr. Prateek Upadhyay

ABSTRACT

Background: Many approaches to brachial plexus block are used routinely for upper limb orthopedic surgery. Aim was to compare the effectiveness of vertical approach of infraclavicular block using electrostimulation and transarterial axillary block and also the success rate of infraclavicular block achieved by posterior cord stimulation technique with that of the lateral or medial cord. Materials and Methods: In a prospective randomized double blind study, 60 patients of American Society of Anesthesiologists grades I and II of either sex, 20–60 years of age were included after approval from the Ethics Committee. Informed consent was taken and patients were randomly divided into two groups of 30 each, to receive either a vertical infraclavicular plexus block (Group I) or transarterial axillary block (Group A). Patients were monitored for sensory and motor block characteristics, haemodynamics, side effects and postoperative complications. Results: Block performance time (min) for single injection infraclavicular block using nerve stimulator was significantly longer in Group I (7.10±0.80 min) as compared to single injection transarterial axillary block in Group A (3.70±0.95 min).Incidence of successful block was higher in Group I as compared to Group A in axillary nerve (76.7% vs 33.3% , P=0.001), MCN (86.7% vs 40% , P=0.0004) and ICBN (83.3% vs 10% , P=0.0001).Onset time of sensory block was significantly shorter in Group A in axillary nerve (P=0.005), MCN (P= 0.0004), ulnar nerve (P= 0.002), MCNA (P= 0.019) as compared to Group I. Success rate was significantly higher when drug was injected after posterior cord stimulation (100%) as compared to lateral cord stimulation (55.6%) , P=0.017. Patients remained hemodynamically stable and side effects and complications were comparable in both groups. Data was analyzed using “Chi square test”, paired „t‟ test, student „t‟ test and analysis of variance (ANOVA). Conclusion: Vertical infraclavicular block provided higher incidence of complete sensory block as compared to transarterial axillary block. Success rate was significantly higher with posterior cord stimulation technique as compared to lateral cord or medial cord.

Keywords: Vertical Infraclavicular Block, Transarterial Axillary Block, Upper Limb Orthopedic Surgery, Ropivacaine.