DOI: 10.36347/sjams.2018.v06i11.037

Pages: 4365-4368

Fractures of proximal upper extremity present a challenge to the anaesthesia provider when administering a regional anaesthetic because the dermatomal distribution of the upper extremity requires more local anaesthetic coverage than any single Brachial plexus nerve block can provide. In our study we have demonstrated the ability to reduce local anaesthetic volumes to achieve equipotent results as well as reduce side effects associated with certain blocks. A randomized controlled prospective study consisting of 60 patients (ASA I and II) who were allocated into Group A (Interscalene + Supraclavicular block) Group B (Interscalene block). Inj. Midazolam 0.5–2 mg I.V. as premedication. Using standard monitors, the blocks were performed with ultrasound and 22-gauge insulated needle. The anaesthetic solution consisted of 0.5% Bupivacaine 30 ml given in each Group. In Group a 20 ml of drug was given in interscalene block and 10 ml of drug was given in Supraclavicular block. Better patient comfort and motor blockade was observed in combined block. Incidence of Horner’s syndrome was less in patients with combined block. Brachial plexus blocks performed under ultrasound guidance can be used in combination, to safely reduce analgesic and anaesthetic requirements, to obtain complete postoperative pain coverage of the upper extremity without placing the patient at additional risk of local anaesthetic toxicity.