Combination of Supraclavicular and Low Interscalene Block with Bupivacaine 0.5%

Abstract

Background: Surgical procedures on the shoulder and upper limb are ideally suited FOR regional anaesthetic techniques as they are associated with higher degrees of success and lesser incidence of complications. Use of classical interscalene block alone is associated with diaphragmatic paresis and respiratory complications. Supraclavicular and infraclavicular block alone are sometimes not adequate for upper limb surgeries and may be associated with tourniquet pain. With these in mind, it was thought to combine both techniques together to get adequate surgical Anaesthesia with lesser complications. Patients & Methods: After Ethics committee approval and infirmed consent, 30 patients of ASA I, II and III posted for shoulder and upper limb surgeries were administered combined low interscalene and supraclavicular block by paresthesia technique with a mixture of bupivacaine 0.5% and lignocaine 5% heavy (5:1), total volume administered 30 ml. Onset time of sensory and motor block as per Hollmen scale was recorded. Duration of analgesia and motor block was recorded. Results: Mean onset time of sensory analgesia was 2 min.30 sec ± 20 sec and motor block at 3 min.10 sec ± 20 sec. Analgesia lasted for a mean duration of 906 ± 217 minutes till first request for additional analgesic. None of the patients needed to be supplemented with general Anaesthesia. None of the patients had complaints of breathing difficulty, or had clinical evidence of accessory muscles of respiration being in use or a drop in saturation below 90%, suggestive of diaphragmatic palsy or pneumothorax. Conclusions: To conclude, use of combined interscalene and supraclavicular approach to block the brachial plexus was found to be effective as a sole anaesthetic technique with no respiratory compromise.