Low dose interscalene with superficial cervical plexus block versus superior trunk, supraclavicular nerve and superficial cervical plexus block for mid and lateral clavicular surgeries in adult patients- A randomized double-blind study.

Abstract

Abstract

Background and aims: Interscalene brachial plexus with superficial cervical plexus

block has been the procedure of choice performed regularly

 to provide analgesia for clavicular surgeries. However, the phrenic nerve is invariably involved in the block resulting in hemi-diaphragmatic paresis. With the frequent use of ultrasound for nerve blocks, superior trunk, supraclavicular nerve and superficial cervical plexus can be blocked specifically to provide analgesia using low doses of local anaesthetic drug for clavicular surgeries in adult patients. Thus, the complications of usage of large doses of drug can be prevented, but with effective analgesia.

Methods: 80 adult patients of American Society of Anaesthesiology I&II, undergoing clavicular surgeries were randomized into two groups. Group ST received 6ml, 2ml and 5ml of 0.5% bupivacaine for superior trunk plus supraclavicular nerve and superficial cervical plexus block respectively. Group IS received interscalene brachial plexus block and superficial cervical plexus with 8 ml and 5 ml of 0.5% bupivacaine respectively. Hemi-diaphragmatic paresis, loss of pin prick sensation in 10 minutes and need for    rescue analgesia in the intraoperative period was noted.

Results: Data was analyzed using SPSS 22 version software. Chi-square test was used as test of significance for qualitative data and independent t-test for quantitative data. 2.5% of patients in IS group required general anaesthesia due to inadequate analgesia whereas 7.5% in ST were comfortable with bolus dose of fentanyl. 5/40 had hemi diaphragmatic paresis in IS group, compared to 2/40 in ST group at 60 min. There was no statistically significant difference in diaphragmatic movements or block failure between two groups.

 Conclusion: Low dose superior trunk block preserves diaphragm function and provides adequate analgesia for mid and lateral clavicle surgeries in adults in comparison with interscalene block.