Electrostimulation with or without ultrasound-guidance in interscalene brachial plexus block for shoulder surgery

J Anesth. 2012 Aug;26(4):610-3. doi: 10.1007/s00540-012-1366-x. Epub 2012 Mar 4.

Abstract

In a prospective controlled trial to compare conventional interscalene brachial plexus block (ISBPB) using anatomic landmarks and electro-stimulation with a combined technique of ultrasound guidance followed by nerve stimulation, 60 patients were randomized into 2 matched equal groups: Group A using nerve stimulation (NS) alone and Group B using the combination of ultrasound and NS. The time to detect the plexus (3.9 ± 4 min in Group A and 3.3 ± 1.4 min in Group B) was not significantly different. We needed to reposition the needle once (n = 13) or twice (n = 4) in Group B. First-shot motor response was achieved in all but one patient in Group A; here we were only able to locate the plexus by use of ultrasound. None of the patients needed general anaesthesia. There were no significant differences between postoperative pain, motor power, or patient's satisfaction. ISBPB seems similarly effective using electro-stimulation and ultrasound if performed by experienced anesthesiologists.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesia
  • Anesthetics, Local / administration & dosage
  • Brachial Plexus / diagnostic imaging*
  • Brachial Plexus / physiology*
  • Conscious Sedation
  • Electric Stimulation*
  • Female
  • Humans
  • Hypnotics and Sedatives
  • Male
  • Midazolam
  • Middle Aged
  • Muscle, Skeletal / physiology
  • Nerve Block / methods*
  • Orthopedic Procedures
  • Propofol
  • Prospective Studies
  • Shoulder / surgery*
  • Treatment Outcome
  • Ultrasonography

Substances

  • Anesthetics, Local
  • Hypnotics and Sedatives
  • Midazolam
  • Propofol