Clinical outcomes after ultrasound guided supraclavicular brachial plexus blockade for upper limb surgeries at Muhimbili Orthopaedic Institute

Abstract

Short background Upper limb surgeries can be done with regional anaesthesia, general anaesthesia or combination of the two. Ultrasound guided regional anaesthesia has become a popular technique and has transformed Supraclavicular blocks into potentially safe superficial blocks. The improved safety and efficacy that ultrasound brings to regional anaesthesia has helped to promote its use and realize the benefits that regional anaesthesia has over general anaesthesia. Broad objective The objective of this study was to determine clinical outcomes after ultrasound guided supraclavicular brachial plexus blocks among patients who underwent upper limb surgeries at Muhimbili orthopaedic institute. Aim of study. Ultrasound guided blocks is a poorly researched area in our country. No research has been done in ultrasound guided supraclavicular brachial plexus block. This study was done for the purpose of understanding clinical outcomes after ultrasound guided supraclavicular brachial plexus blockade. Methodology. After local ethical committee approval and obtaining informed consent, a hospital based prospective observation cross-sectional study was done in 86 adult patients of both sexes aged 18 years and above who underwent upper limb surgeries under regional anaesthesia by ultrasound guided supraclavicular blocks. The study was done at MOI whereby 0.5% Bupivacaine plain and 2% lidocaine with 1:200000 epinephrine were used. Blocks were performed in supine position with the head turned contralateral to the block site. Block success, motor and sensory blockade, complications, duration of analgesia and patient satisfaction were assessed. Pain assessment was done based on patient’s awareness to pain, using visual analogue scale at recovery (00hrs) and at time of breakthrough analgesia. Patients were followed up to 24 hours for any complications. Data was analyzed using SPSS version 20.0 computer software. Continuous variables were expressed as means and standard deviations. Association between independent and dependent variables was done using independent t-test for continuous variables and chi-square test for categorical variables. Difference was considered statistically significant with a P value of <0.05. Results Ultrasound guided supraclavicular block were performed in 86 patients with a success rate of 97.6% of which 89.5% were successful after the first attempt and 8.1% were successful after supplementation. There were 2.4% failures. The average duration of analgesia was 211.73± 24.79 mins. Mean duration of analgesia had no statistically significant correlation to type of surgery. The most common complication was unintended vascular puncture (9.3%) followed by haematoma (4.7%), Horner’s syndrome (2.3%) and pain and paraesthesia (2.3%). Complications were statistically significant associated with BMI and sex with a P values of <0.001 and 0.02 respectively. Most of the patients were comfortable with the technique. Conclusion The results of the study show very high successful block rate and good analgesia that extends for adequately longer time postoperatively. Patients were satisfied with the block and no serious complications were reported. Therefore, in absence of contraindication, the technique offers the best choice for upper extremities procedures especially to patients with cormobities like chronic renal failure and hypertension where general anaesthesia is associated with increased risk of complications. Recommendation Ultrasound guided supraclavicular block should be routinely done to patients undergoing upper limb surgeries in Tanzania.