Objective: To compare the blockage effect of multiple injection axillary brachial plexus blockage between ultrasound guidance alone and ultrasound guidance plus neurostimulation.
Methods: Upon the approval of institutional ethical committee, a total of 166 patients underwent hand, forearm and distal arm operations under axillary brachial plexus blockage from January to May in 2011 at Department of Hand Surgery, Beijing Jishuitan Hospital. They were randomly allocated to receive either ultrasound guidance plus nerve stimulation (group US-NS, n = 83) or ultrasound guidance alone (group US, n = 83) for nerve localization. Ten milliliter ropivacaine 0.5% was administered separately on each nerve. Blockage time, needle frequency, success rate, onset of sensory and motor blocks, procedure-related complications (vascular puncture, acute nerve injury and tourniquet pain, etc.) and patient satisfaction were recorded.
Results: The procedure time was shorter in US group than in US-NS group [(3.3 ± 1.5) vs (5.3 ± 2.0) min, P < 0.01]. The median (range) number of needle frequency of group US was lower than that of group US-NS [(4.3 ± 0.7) vs (5.6 ± 1.4) temps, P < 0.01]. No intergroup difference existed in success rate. The onset of complete block was shorter in group US-NS than that in group US [(10.6 ± 6.4) vs (12.7 ± 6.9) min, P < 0.05]. Vascular puncture proportion was higher in group US-NS than group US (16/83 vs 1/83, P < 0.01). There was no occurrence of tourniquet pain. Patient acceptance was similar in two groups.
Conclusion: Multiple injection axillary blockage with ultrasound guidance yield similar success rates whether or not combined with nerve stimulation guidance. There appears to be a lower incidence rates of complications for ultrasound guidance alone versus ultrasound guidance plus neurostimulation.