The use of a peripheral nerve stimulator (PNS) has been considered the ‘gold standard’ for performing peripheral nerve blocks for the last two decades and has been shown to be a highly effective technique for determining adequate needle placement to produce regional anaesthesia/ analgesia. However, with recent developments in high-frequency imaging, the use of ultrasound (US) technology has significantly increased for nerve localization.
Aim: To assess and compare between ultrasound guided technique and peripheral nerve stimulator technique for performing brachial plexus nerve block through supraclavicular approach.
Materials and Methods: A prospective randomised study was conducted at Meenakshi Mission hospital and research centre for a period of one year between Nov 2015 and Oct 2016. A total of 60 patients were included in the study and by using a single blinded technique they were randomised into two groups. Group A (n=30) patients received US guided technique for brachial plexus block and group B (n=30) received brachial plexus block through PNS technique. Procedure time, block start time (needle insertion), time to achieve complete sensory blockade, motor blockade, and duration of surgical procedure and duration of analgesia were recorded. Complications occurred if any were also noted.
Results: The mean time required for performing ultrasound guided technique was 2.58 mins and for PNS it was 5.82 mins and the difference was found to be statistically significant. Similarly the time required for achieving the complete nerve blockade was much less among the US guided group in comparison to the PNS group. None of the patients in the ultrasound guided technique required a supplementation of analgesics for the maintenance of anaesthesia, whereas 5 patients in the PNS group had received supplementary analgesia. Moreover none of the patients in the US guided technique group had developed any complications, whereas four patients in the PNS technique group had developed vascular complications.
Conclusion: The present study concludes that US guided technique was superior to PNS technique with respect to procedural time, achievement of complete nerve block and incidence of vascular complications for performing brachial plexus block.