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

• Published in: Journal of anesthesia Vol. 26; no. 4; pp. 610 - 613
• Main Authors: Salem, Mohamed H., Winckelmann, Jörg, Geiger, Peter, Mehrkens, Hans-Hinrich, Salem, Khaled H.
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.08.2012; Springer
• Subjects: Adult; Aged; Aged, 80 and over; Analgesia; Anesthesiology; Anesthetics, Local - administration & dosage; Brachial Plexus - diagnostic imaging; Brachial Plexus - physiology; Conscious Sedation; Critical Care Medicine; Electric Stimulation; Emergency Medicine; Female; Humans; Hypnotics and Sedatives; Intensive; Male; Medicine; Medicine & Public Health; Midazolam; Middle Aged; Muscle, Skeletal - physiology; Nerve Block - methods; Orthopedic Procedures; Orthopedic surgery; Pain Medicine; Propofol; Prospective Studies; Short Communication; Shoulder - surgery; Treatment Outcome; Ultrasonography; Nerve stimulation; Ultrasound; Interscalene brachial plexus block
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-012-1366-x

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.