Ultrasound-guided supraclavicular nerve block in-plane technique: Comparison of conventional vs skin wheal standoff technique
Depinder Kaur1, Harshita Surange2, Pankaj N Surange3, Saurabh Anand4, Amit Choudhary5, Suchitra Malhotra6
1 Assistant Professor, Department of Anesthesia, Shaheed Hasan Khan Mewati Government Medical College, Mewat, Haryana, India
2 Director, Department of Radiology, Diagnostic and Imaging Centre, New Delhi, India
3 Director, Department of Pain Medicine, Interventional Pain and Spine Centre, New Delhi, India
4 Head, Department of Neuroanesthesia, Artemis Hospitals, Gurugram, Haryana, India
5 Professor, Department of Anesthesia, Shaheed Hasan Khan Mewati Government Medical College, Mewat, Haryana, India
6 Associate Professor, Department of Anesthesia, Shaheed Hasan Khan Mewati Government Medical College, Mewat, Haryana, India
Assistant Professor, Department of Anesthesia, Shaheed Hasan Khan Mewati Government Medical College, Mewat, Haryana
Source of Support: None, Conflict of Interest: None
Introduction: The foremost advantage of ultrasound-guided peripheral nerve blocks is visualization of anatomical structures of interest and then depositing the local anesthetic for block. Supraclavicular block is the very commonly used block for upper limb surgeries.
Aim: The aim of our study is that for greater efficacy and safety of our blocks, we should use a technique in which we are not only visualizing the anatomical structures, but also the complete needle path and ultimately the deposition of local anesthetic in the vicinity of nerves and having a safe distance from adjacent structures like vessels and pleura.
Materials and methods: A total of 60 patients were accepted for study and divided into two groups of 30 each randomly. In group I, ultrasound-guided supraclavicular nerve block was given with skin wheal oblique standoff technique and in group II, the usual technique. Both the groups were compared in terms of better needle visualization, number of attempts, and success of block.
Results: In group I, we were able to visualize the complete path of needle in 70% of cases in first attempt as compared with group II in 40% of cases. In group I, 70% of blocks were placed in the first attempt as compared with 33% in group II. The p-value was <0.005 and difference was statistically significant. Similarly, operator fatigue, time for block placement, and corner pocket visualization were better in group I.
Conclusion: We have an opinion and recommendation from this study that by simple modification of the usual technique of giving supraclavicular block, i.e., raising a skin wheel, we can achieve greater success with our procedure.