Systemic Evaluation And Case Ananysis Of Efficacy And Safety Of Ultrasound-guided Brachial Plexus Block

Objective: In order to systematically evaluate efficacy and safety ofultrasound-guided brachial plexus block for adult patients under upper-limb surgery.Methods:Part1: Randomized controlled trials on the application of ultrasound-guided andnon-ultrasound-guided brachial plexus block for adult patients under upper-limb surgerywere included according to the established inclusion and exclusion criteria,as well as theliterature that met the evaluation criteria,after comprehensive search in domestic andforeign databases. Statistical analysis was performed by using Review Manager5.2software. The evaluation indicators included the block performance time,block successrate,block onset time and the indication rate of complications.Part2: Ten adult patients (ASA Ⅰ~Ⅱ) undergoing upper extremity operations wererandomly selected to receive ultrasound-guided interscalene brachial plexus block, addingsuperficial cervical plexus block if necessary.0.5%ropivacaine was used by block in30ml. Theblock performance time, the onset time of sensory and motor block, the anesthetic effect(usage of sedative/analgesic drugs or change to general anesthesia), the adverse reactionsduring the whole procedure of block and the surgery, the sustained time of sensory blockand motor block were recorded.Results:Part1: Eighteen randomized controlled trials with1154patients were included.Therewere777patients in the ultrasound-guided group and767patients in thenon-ultrasound-guided group.After Meta-Analysis by RevMan5.2,the block performancetime was shorter in the ultrasound-guided group than that in the non-ultrasound-guidedgroup(P<0.05).The rate of successful block that could meet the need for surgery washigher in the ultrasound-guided group than that in the non-ultrasound-guidedgroup(P<0.05).The block onset time was shorter in the ultrasound-guided group than thatin the non-ultrasound-guided group(P<0.05).The incidence rate of complication was lowerin the ultrasound group than that in the non-ultrasound-guided group(P<0.05).Part2: All blocks are completed in less than6min. All patients reached maximum sensory block(score of1)and motor block(score of2) after a period of time,except onepatient,whose maximum sensory block score of radial nerve was2.Two patients weregiven100mg flurbiprofen i.v. to complete the surgery because of feeling a slight pain in theincision, anesthetic effect marked as "good". One patient was given0.05mg Fentanyl i.v. tocomplete the surgery because of feeling obvious pain in the incision, anesthetic effectmarked as "good".Others were given no drugs, anesthetic effect marked as "excellent". Thesustained time of sensory block was9-14hours,and motor block was5-17hours.Sensoryand motor functions after surgery were the same as before in all patients.Four patients feltparesthesia,one Horner’s syndrome and phrenic nerve block,two slight pain,one obviouspain and three nausea and vomiting were observed.Conclusions: Ultrasound-guided brachial plexus block provides better efficacy andhigher safety than non-ultrasound-guided technique.However,large scale randomizedcontrolled trials was needed for further study.