 In experienced hands, ultrasonography and neurostimulation have similar success rates and a comparable incidence of complications |
| Casati et al. | An article published in the journal Anesthesiology describes a randomised, controlled study in which it was found that ultrasonography and neurostimulation have comparable efficacy and tolerablity for guiding multiple injection axillary block.
In this study, carried out at the University of Parma, Italy, the authors, Andrea Casati and co-workers, hypothesised that ultrasound guidance would shorten the onset of axillary brachial plexus block compared with nerve stimulation guidance, which is currently the gold standard technique for nerve location.
They recruited 60 patients undergoing elective upper limb surgery, including forearm, wrist and hand procedures, all of whom were ASA I–III and received axillary brachial plexus block with 20 ml ropivacaine 0.76% using a multiple injection technique, under either nerve stimulation or ultrasound guidance.
Casati et al. evaluated a range of endpoints, including the median number of needle passes, the time to onset of sensory and motor block, readiness to surgery, block failure or insufficiency, and procedure-related pain.
Of these parameters, only the onset of sensory block differed between the groups, being significantly shorter among patients under ultrasound guidance than those with neurostimulation (14 versus 18 minutes). Patient acceptance was similarly good in both groups, and all patients had complete recovery of sensory and motor function.
The authors note that patients in the ultrasound group had just four needle passes, on average, compared with eight in the nerve stimulation group. Although this difference was not statistically significant, it would be expected to reduce procedure-related pain and improve patient acceptance.
The authors conclude: “In experienced hands, ultrasonography and neurostimulation have similar success rates and a comparable incidence of complications. Patient satisfaction was similarly good with both techniques”.
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