Ultrasound-guided supraclavicular brachial plexus block in hand and forearm surgery: Case series

Abstract

Objective: Paresthesia technique or nerve stimulator-guided supraclavicular brachial plexus block can cause nerve injury, patient’s discomfort, and dissatisfaction during the procedure. The present study aimed to retrospectively review the practice of ultrasound-guided supraclavicular brachial plexus block for orthopedic hand and forearm surgery. Materials and Methods: Medical records of 175 patients receiving ultrasound-guided supraclavicular brachial plexus block for hand and forearm surgery, between January 2013 and December 2015, were retrospectively reviewed. The anatomical sonography of supraclavicular area was imaged by 2-D linear probe. The needle was advanced by in-plane technique and lateral to median direction. Multiple sites injection was needed depending on the visibility of spreading of local anesthetic agent. Complete block, block with intravenous opioids supplement, and block with additional ulnar nerve block were defined as successful block. Failed block was defined as the conversion to general anesthesia. Results: Brachial plexus block in 170 patients (97.14%) were successful whereas five patients (2.86%) were converted to general anesthesia with laryngeal mask airway. There was no serious complication such as pneumothorax or intravascular injection. Conclusion: Ultrasound-guided supraclavicular brachial plexus block with linear probe and in-plane needle advancement provided high success rate and low complication. © 2018, Medical Association of Thailand. All rights reserved.