Dr. Sudhir Tichkule, Dr. Sunil Kumar Jain


BACKGROUND AND OBJECTIVES: Ultrasound in Regional Blocks is increasingly more frequent. Very few studies comparing ultrasound and neurostimulation have been conducted. The objective of this study was to compare neurostimulation-guided axillary brachial plexus block with double injection and ultrasound-guided axillary plexus block for hand surgeries. The time to perform the technique, success rate, and complications were compared.

METHODS: After approval by the Ethics on Research Committee  40 patients scheduled for elective Forearm surgeries under axillary plexus block were selected. Patients were randomly divided into two groups with 20 patients each: Neurostimulation (NE) and Ultrasound (US) groups. The time to perform the technique, success rate, and complication rate were compared.

RESULTS: Complete blockade, partial failure, and total failure rates did not show statistically significant differences between the US and NE groups. The mean time to perform the technique in the US group (354 seconds) was not statistically different than that of the NE group (381 seconds). Patients in the NE group had a higher incidence of vascular punctures (40%) when compared with those in the US group (10%, p < 0.05). The rate of paresthesia during the blockade was similar in both groups (15%).

CONCLUSIONS: The success rate and time to perform the blockade were similar in ultrasound- and neurostimulation-guided axillary plexus block for hand surgeries


axillary plexus block , Neurostimulator, Ultrasound.

Full Text:



Brull R, Perlas A, Chan VW - Ultrasound-guided peripheral nerve blockade. Curr Pain Headache Rep, 2007;11:25-32.

Neal JM, Gerancher JC, Hebl JR et al. - Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med, 2009;34:134-170.

Sia S, Lepri A, Ponzecchi P - Axillary brachial plexus block using peripheral nerve stimulator: a comparison between double- and triple-injection techniques. Reg Anesth Pain Med, 2001;26:499-503

Marhofer P, Chan VW - Ultrasound-guided regional anesthesia: current concepts and future trends. Anesth Analg, 2007;104:1265-1269.

Sites BD, Brull R - Ultrasound guidance in peripheral regional anesthesia: philosophy, evidence-based medicine, and techniques. Curr Opin Anaesthesiol, 2006;19:630-639.

Conceição DB, Helayel PE, Carvalho FAE et al. - Imagens ultrasonográficas do plexo braquial na região axilar. Rev Bras Anestesiol, 2007;57:684-689.

Helayel PE, Conceição DB, Nascimento BS et al. - Curva de aprendizado da sonoanatomia do plexo braquial na região axilar. Rev Bras Anestesiol, 2009;59:187-193.

Helayel PE, Conceição DB, Oliveira Filho GR - Bloqueios nervosos guiados por ultra-som. Rev Bras Anestesiol, 2007;57:106-123.

Abrahams MS, Aziz MF, Fu RF et al. - Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth, 2009;102:408-417

Liu SS, Ngeow JE, Yadeau JT - Ultrasound-guided regional anesthesia and analgesia: a qualitative systematic review. Reg Anesth Pain Med, 2009;34:47-59

Casati A, Danelli G, Baciarello M et al. - A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology, 2007;106:992-996.

Chan VW, Perlas A, McCartney CJ et al. - Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth, 2007;54:176-182.

Sites BD, Beach ML, Spence BC et al. - Ultrasound guidance improves the success rate of a perivascular axillary plexus block. Acta Anaesthesiol Scand, 2006;50:678-684.

Rucci FS, Barbagli R, Pippa P et al. - The optimal dose of local anaesthetic in the orthogonal two-needle technique. Extent of sensory block after the injection of 20, 30 and 40 mL of anaesthetic solution. Eur J Anaesthesiol, 1997;14:281-286

Nakagawa M, Mammoto T, Hazama A et al. - Midazolam premedication reduces propofol requirements for sedation during regional anesthesia. Can J Anaesth, 2000;47:47-49.


  • There are currently no refbacks.