Comparative study between nerve stimulator guided technique and ultrasound guided technique of supraclavicular nerve block for upper limb surgery

Anil Ratnawat, Fateh Singh Bhati, Chanda Khatri, Bharath Srinivasan, Pushpender Sangwan, Dilip Singh Chouhan


Background: Peripheral nerve stimulator (PNS) has been the ‘gold standard’ for peripheral nerve blocks for determining adequate needle placement to produce regional anesthesia/analgesia. Modern ultrasound (US) machines can be used to guide the injection needle while minimizing the risk of injury of adjacent structures.the main objective of the study was to compare nerve stimulator guided technique and ultrasound guided technique of supraclavicular brachial plexus block for upper limb surgery

Methods: This prospective randomized single blind comparative study was conducted in eighty patients under supraclavicular brachial plexus block using 0.5% Ropivacaine at a tertiary care teaching hospital of Rajasthan after taking approval from ethical committee. These patients were randomly allocated in either group PNS (n=40) or group US (n=40). Both the groups were assessed for procedure time, onset and duration of sensory and motor blockade and complications.

Results: The procedure time was 8.0±1.53 minutes in group PNS and 6.27±1.10 minutes in group US (p˂0.0001). The onset of sensory and motor block was 7.68±1.33 minutes and 9.94±1.28 minutes in group PNS and 6.46±1.02 minutes and 8.10±1.02 minutes respectively in group US (p˂0.0001). The time to achieve complete block was 16.11±1.54 minutes in group PNS and 13.74±1.11 minutes in group US (p˂0.0001). The duration of sensory and motor block was 7 hours and 6 hours for group PNS and 8 hours and 7 hours respectively in group US. The success rate was 90% in group PNS and 97.5% in Group US.

Conclusion: Ultrasound guided technique was found significantly better than PNS for supraclavicular brachial plexus block.



Peripheral nerve stimulator, Supraclavicular brachial plexus block, Ultrasound, Upper limb surgery

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Kulenkampff D, Persy MA. Brachial plexus anesthesia: its indications, technique and dangers. Ann Surg. 1928;87:883-91.

Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJ, Franco CD et al. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med. 2009;34:134-70.

Greenblatt GM, Denson JS. Needle nerve stimulator-locator: nerve blocks with a new instrument for location of nerves. Anaesth Analg. 1962;41:599-602.

Sia S, Bartoli M, Lepri A, Marchini O, Ponsecchi P. Multiple-injection axillary brachial plexus block: a comparison of two methods of nerve localization—nerve stimulation versus paresthesia. Anaesth Analg. 2000;91:647-51.

Winnie AP. Does the transarterial technique of axillary block provide a higher success rate and lower complication rate than a paresthesia technique? Reg Anaesth. 1995;20:482-5.

Baranowski AP, Pither CE. A comparison of three methods of axillary brachial plexus anaesthesia.Anaesthesia. 1990;45:362–5.

Chan VW, Brull R, McCartney CJ, Xu D, Abbas S, Shannon P. An ultrasonic and histologic study of intraneural injection and electrical stimulation in pigs. Anaesth Analg. 2007;104:1281-4.

Schwemmer U, Schleppers A, Markus C, Kredel M, Kirschner S, Roewer N. Operative management in axillary brachial plexus blocks: Comparison of ultrasound and nerve stimulation. Anaesthesist. 2006;55:451-6.

La Grange P, Foster P, Pretorius L. Application of the doppler ultrasound blood flow detector in supraclavicular brachial plexus block. BJA 1978;50:965-7.

Abramowitz HB, Cohen C. Use of Doppler for difficult axillary block. Anaesthesiology. 1981;55:603.

McCartney CJ, Brull R, Chan VW, Katz J, Abbas S, Graham B, et al. Early but no long term benefit of regional compared with general anaesthesia for ambulatory hand surgery. Anesthesiology. 2004;101:461-7.

Aromaa U, Lahdensuu M, Cozanitis DA. Severe complications associated with epidural and spinal anaesthesia in Finland 1987-1993. A study based on patient insurance claims. Acta Anaesthesiol Scand. 1997;41:445-52.

Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuroaxial blockades in Sweden 1990-1999. Anesthesiology. 2004;101:950-9.

Pathak RG, Anand PS, Rajendra NK. Supraclavicular brachial plexus block with and without Dexamethasone – A Comparative Study. Int J Sci Res Publ. 2012;12:1-7.

Singh G, Mohammed YS. Comparison between conventional technique and ultrasound guided supraclavicular brachial plexus block in upper limb surgeries. IJSS. 2014;2(8):169-76.

Rupera KB, Khara BN, Shah VR, Parikh BK. Supra-Clavicular Brachial Plexus Block: Ultra-Sonography Guided Technique Offer Advantage Over Peripheral Nerve Stimulator Guided Technique. Natl J Med Res. 2013;3(3):241-4.

Williams SR, Couinard P, Arcand G, Harris P, Ruel M, Boudreault D, et al. Ultrasound guidance speeds execution and improves the quality of supraclavicuar block Anesth Analg. 2003;97:1518-23.

Simpson G, Nicholls B. Use of ultrasound in chronic pain medicine. Part 1: neuraxial and sympathetic blocks. Contin Educ Anaesth Crit Care Pain. 2013;13:145-51.

Yuan JM, Yang XH, FU SK, Yuan CQ, Chen K, LI Ji, et al. Ultrasound guidance for brachial plexus block decreases the incidence of complete hemi-diaphragmatic paresis or vascular punctures and improves success rate of brachial plexus nerve block compared with peripheral nerve stimulator in adults. Chin Med J. 2012;125:1811-6.

Kapral S, Krafft P, Eibenberger K, Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg. 1994;78:507-13.

Liu GY, Chen ZQ, Jia HY, Dai ZG, Zhang XJ. The technique comparison of brachial plexus blocks by ultrasound guided with blocks by nerve stimulator guided. Int J Clin Exp Med. 2015;8(9):16699-703.