Article

Brachial plexus block with or without ultrasound guidance

Division of Anesthesiology and Intensive Care Medicine, Oslo University Hospital, Rikshospitalet, 0027 Oslo, Norway.
Current opinion in anaesthesiology (Impact Factor: 2.53). 07/2009; 22(5):655-60. DOI: 10.1097/ACO.0b013e32832eb7d3
Source: PubMed

ABSTRACT Should ultrasound or nerve stimulation be used for brachial plexus blocks? We investigated last year's literature to help answer this question.
Many of the reports concluded that ultrasound guidance may provide a higher success rate for brachial plexus blocks than guidance by nerve stimulator. However, the studies were not large enough to conclude that ultrasound will reduce the risk of nerve injury, local anesthetic toxicity or pneumothorax. Ultrasound may reveal anatomical variations of importance for performing brachial plexus blocks. For postoperative analgesia, 5 ml of ropivacaine 0.5% has been sufficient for an ultrasound-guided interscalene block. For peroperative anesthesia, as much as 42 ml of a local anesthetic mixture was calculated to be appropriate for an ultrasound-guided supraclavicular method. For the future, we notice that three-dimensional and four-dimensional ultrasound technology may facilitate visualizing the needle, the nerves and the local anesthetic distribution. Impedance measurements may be helpful for nerve blocks not guided by ultrasound.
We think that the literature gives a sufficient basis to recommend the use of ultrasound for guidance of brachial plexus blocks. The potential for ultrasound to improve efficacy and reduce complications of brachial plexus blocks requires larger scaled studies.

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    • "Ultrasound demonstrates in real time the relative locations of the needle, the nerves of interest, the structures to be avoided by the needle (i.e. blood vessels) and the distribution of local anaesthetic injected (Klaastad et al. 2009). For these reasons, ultrasound-guided nerve blocks may be advantageous compared to 'blind' techniques (including neurostimulation). "
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    • "All NS-guided procedures are guided by (varying) anatomical landmarks and in-depth nerve stimulation, by which the target nerves are only indirectly located by their muscular responses. As such NS-guided blocks have been the standard method for about 30 years, but the application of ultrasound has increased substantially during the last 15 years (Klaastad et al., 2009; Marhofer et al., 2010). Recently, however, the value of stimulation thresholds between 0.3 and 0.5 mA as reliable parameter for extraneural needle tip placement has been challenged in animal studies (Chan et al., 2007; Tsai et al., 2008) and very recently in humans (Bigeleisen et al., 2009). "
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