The Clinical Application Study Of High-frequency Ultrasound-guided Technique In Interscalene And Axillary Brachial Plexus Blocks

Objective To discuss whether the high-frequency ultrasound-guided technique issuperior to traditional anatomy-guided technique for interscalene brachial plexusblock，and whether it can reduce the dosage of the local anaesthetic. And to comparethe advantages and disadvantages of using high-frequency ultrasound-guided forbrachial plexus block between interscalene approach and axillary approach.Methods60Patients for upper extremity operation under interscalene brachialplexus block（BPB）been recruited were divided randomly into four groups esch had15cases according to the different guiding technique and local anaesthetic dose.GroupA with normal dose（20ml）local anaesthetic using traditional anatomy-guided methodin single-injection;Group B with normal dose（20ml）local anaesthetic usingultrasound-guided method in double-injection（10ml each）;Group C with low dose（14ml） local anaesthetic using traditional anatomy-guided method insingle-injection;Group D with low dose（14ml）local anaesthetic using ultrasound-guided method in double-injection （7ml each）.The block operation time,sensory andmotor block onset time and complications were recorded respectively.40patientspresenting with elective upper limb surgery were prospectively randomized to receivean interscalene BPB(Group IS) or an axillary BPB (Group AX)using high-frequencyultrasound-guided method in double-injection.record operation time,The blockoperation time,block effect and complications were recorded respectively，and tocompare the results of the two approaches.Results Group ultrasound-guided（Group UG）method block had higher one timesuccess rate of operation and success rate of block（low dose）than the Group anatomy -guided（Group AG）（30/30vs13/30;P<0.05）及（100%vs26.67%;P<0.05）;Theoperation time of block in Group UG were shorter obviously than that in Group AG（4.17±1.02min vs6.97±1.45min;P<0.05）;The sensory and motor block onset timein Group D were not statistically significant compare to the Group B or A (P>0.05),but better than Group C obviously（P<0.05）;The Group D or B had lower incidenceof complications than the Group C or A（P<0.05）.There was no significant differencein block success rate between Group IS and Group AX（90%vs85%；P>0.05）;Theoperation time of block in Group IS were shorter obviously than that in Group AX（4.55±0.98min vs7.41±1.06min；P<0.01）,but the block onset time longer than inGroup AX（20.00±7.47min vs16.76±6.83min；P<0.01）.However, both in totalanesthesia-related time difference was not statistically significant（24.55±8.21min vs24.18±7.25min；P>0.05）.Group AX had fewer complications comparing with GroupIS.and had better blockage effect for musculocutanrous nerve.Conclusion High-frequency ultrasound-guided technique in double-injectioninterscalene brachial plexus block had the advantages of shorter operation time ofblock, higher block success rate, shorter block onset time,fewer complicationscomparing with traditional anatomy-guided technique in single-injection.High-frequency ultrasound-guided technique in double-injection interscalene brachialplexus block can reduce local anaesthetic amount and reduce the incidence ofcomplications.High-frequency ultrasound-guided in double-injection for brachialplexus block between interscalene approach and axillary approach have advantageseach other,Clinical may choose the appropriate way according to the different needs.