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indexed in Scopus
Year 2013 Vol. 21 No 6
INTERSCALENE BRACHIAL PLEXUS BLOCK IN PATIENTS WITH CLAVICLE FRACTURES: RANDOMIZED COMPARISON OF TECHNIQUES WITH ULTRASOUND GUIDANCE AND NEUROSTIMULATOR
National Medical University named after O.O. Bogomolets, Kiev,
Objectives. To investigate the effectiveness of the interscalene brachial plexus block controlled by the ultrasound in comparison with the technique controlled by means of the neurostimulator in patients with clavicle fractures.
Methods. 60 patients with the clavicle fractures were accidentally randomized into 2 study groups, each numbering 30 patients depending on the applied technique of the interscalene brachial plexus block. Patients in both groups were similar for the gender, age and local changes difficult to determine the site of puncture needle. In the first group the brachial plexus was identified by means of neurostimulator according to a standard motor response. In the second group the brachial plexus identification and introduction of the local anesthetic was controlled by means of the ultrasound. The rate of successful block, expended time and the number of needle punctures for performing manipulation have been compared.
Results. It is established that the use of ultrasound guidance at the interscalene brachial plexus block leads to the increase of successful regional anesthesia frequency (100% vs. 80%). The relative chances on the unsuccessful block at the electrolocation application concerning the ultrasound control made up 13,16. Ultrasound guidance permits to reduce the manipulation time 215 [180-300] sec vs. 600 [350-750] sec) and the number of the needle punctures (1 [1-2] vs. 3 [2-4]) during searching the plexus, which reduces patient’s discomfort during anesthesia as well as decreases the risks of complications.
Conclusions. In patients with the clavicle fractures interscalene brachial plexus block performance with the use of neurostimulator is complicated by anatomical landmarks changes and pain syndrome at their detection. Application of the ultrasound guidance technique can improve the results of regional anesthesia in these patients.
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01133, Ukraina, g. Kiev, Laboratornyi pereulok 14-20, Kievskaia gorodskaia klinicheskaia bol'nitsa ¹17, otdelenie anesteziologii i intensivnoi terapii,
Kuchyn Iuri Leonidovich
Kuchyn Iu.L. PhD, associate professor of the anesthesiology and intensive therapy chair of the National Medical University named after O.O. Bogomolets.