Comparative evaluation of interscalene and interscalene plus infraclavicular brachial plexus block for elbow surgery using nerve stimulator

Abstract

Objective: This study was conducted to compare interscalene block and interscalene plus infraclavicular brachial plexus block for elbow surgery using nerve stimulator. Methodology: Sixty male patients, age 20-60 years, ASA physical status I or II, scheduled for above right elbow surgery under brachial plexus block, were included in this prospective, randomized study. Patients were randomly allocated into two groups. Block was performed via the interscalene approach in the Group I and combined approach of interscalene with infraclavicular approach in the Group II, using a peripheral nerve stimulator. Total volume of 0.25% bupivacaine was kept 40 ml in both the groups. Onset and duration of sensory and motor blocks, quality of block and complications were noted. Evaluation of sensory and motor blockade onset were performed every 5 min after needle withdrawal and then up to 30 min. Primary outcome was satisfactory block (in terms of complete block, partial failure of block and complete failure of blocks). All statistical analyses were performed using INSTAT for windows. Continuous variables were tested for normal distribution by the Kolmogorov-Smirnov test. Data was expressed as either mean and standard deviation or numbers and percentages. Demographic data were compared using student's unpaired t test. The monitored and calculated parameters were analyzed using Student's t-Test and x2 test. A p value < 0.05 was considered significant. Results: There was quick onset of sensory (C7-T1 dermatome) and motor block as well as prolonged sensory and motor block was observed in Group II as compared to Group I (P < 0.05). Number of rescue analgesic requirement in Group I was significantly higher than Group II. Incidence of hoarseness of voice was more in Group I. Conclusions: We conclude that combined approach of interscalene and infraclavicular brachial plexus block is clinically and statistically superior as compared to interscalene brachial plexus block alone in elbow surgery.