INTERSCALENE BRACHIAL PLEXUS BLOCK; A COMPARATIVE STUDY BETWEEN NERVE STIMULATOR AND ULTRASOUND GUIDANCE IN SHOULDER SURGERY

Ultrasonography seems to be the most suitable image modality for regional anesthesia. Perhaps the most significant advantage of ultrasound technology is the ability to provide anatomic examination of the area of interest in real-time, allows one to visualize neural and the surrounding structures and visualize the pattern of local anesthetic spread. The aim of this study was to evaluate the ultrasound guided nerve detection in interscalene brachial plexus block and comparing it with nerve stimulator guided nerve detection regarding simplicity, safety and efficacy. Material methods; sixty patients were scheduled for unilateral shoulder surgery, shoulder arthroscopy or surgical neck humerus surgery. They were randomly divided into two groups (30 patients in each group) Group I: those patients who receive an interscalene brachial plexus block via ultrasound guidance. Group II: those patients who receive an interscalene brachial plexus block via nerve stimulator guidance. Results; Time required to perform the procedure was significantly less in group I = 5(1) min compared to group II = 6.2(1.3) min. The block was successful in all patients of group I while 2 patients in the nerve stimulator group (group II) failed to achieve complete surgical block but the patients were withdrawn from the study. This failure was statistically not significant. Morphine consumption was statistically lower in group I 4 (1) mg/24h than in group II 7 (1) mg/24h. The undesirable events were not observed among patients in group I, while three patients of group II (10%) had a complicated course as delayed paraesthesia , dyspnea, tinnitus and circumoral numbness but the difference between both groups was not statistically significant (p 0.05). the degree of satisfaction showed a significant difference favoring ultrasound guidance (group I) (86.6%) compared to group II (53.3%). Conclusion; ultrasound guidance interscalene block offers shorter time, faster onset, prolonged duration of analgesia, more patient satisfaction and less morphine consumption for postoperative analgesia, With no significant difference as regard the success rate and complications, in comparison with the nerve stimulator guided interscalene block.