Randomized comparative study between single-injection, intracluster-injection and double-injection ultrasound-guided supraclavicular block of brachial plexus / Ahmed Mahmoud Hussien ; Supervised Ashraf Rady Ahmed , Ahmed Ibrahim Abdelkhalk , Sherin Refaat Mahmoud

Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Anaesthesia

Background and Objectives: This prospective, randomized, comparative study compared single-injection, intracluster-injection and double-injection, ultrasound-guided supraclavicular brachial plexus block for forearm surgery. Methods: Thirty-six patients were randomly allocated to receive a single-injection (n=12), intracluster-injection (n=12) or double-injection (n=12), ultrasound-guided supraclavicular block. Onset time (defined as the time required to obtain 14 points), duration of the block, the time of first rescue analgesic by the patient and the incidence of complications were recorded. The primary outcome variable was the onset time. Results: The onset time was shorter with the intra-cluster technique (8.17 mins [SD, 1.64 mins] vs 12.58 mins [SD, 1.83 mins] in double-injection technique and 18 mins [SD,2.45] in single-injection technique; P<0.001); however, duration was also longer (444.17 mins [SD, 64.73 mins] in double-injection technique vs 310 mins [SD, 50.09 mins] in intracluster-injection technique and 125.83 mins[SD 43.32 mins]; P<0.001). Only one patient in doudle-injection technique developed Horner's syndrome. Conclusion: Both intracluster-injection and double-injection ultrasound-guided supraclavicular approaches to the brachial plexus provided comparable satisfactory sensory and motor blocks in patients undergoing surgery of the forearm. Both blocks provided very good analgesia that extended for a long time postoperatively

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