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. 2023 Mar 1;15(3):e35667.
doi: 10.7759/cureus.35667. eCollection 2023 Mar.

Multimodal Approach in Minimizing Transient Neurological Complications Following Single Shot Brachial Plexus Block: A Prospective Observational Study

Parul Kaushik  1 , Nitin Hayaran  1 , Ishan Goel  2
Affiliations

Multimodal Approach in Minimizing Transient Neurological Complications Following Single Shot Brachial Plexus Block: A Prospective Observational Study

Parul Kaushik et al. Cureus. .

Abstract

Purpose: The aim of the study was to assess the benefit of a using multimodal approach, including injection pressure monitoring (IPM) and different techniques of nerve localization, with respect to complications following single-shot brachial plexus block (SSBPB).

Methods: In this study, 238 adults (132 males and 106 females) undergoing upper-limb surgeries under peripheral nerve block (PNB) were evaluated. Of these, 198 patients were given supraclavicular block, and 40 patients received interscalene block using either ultrasound (USG) and peripheral nerve stimulation (PNS) or PNS alone. Injection pressure monitoring was used in 216 patients.

Results: Transient neurological deficit (TND) was observed in six out of 198 patients where USG and NS were used along with IPM as opposed to 12 out of 18 patients without IPM (p<0.0001). In patients where only PNS was used, transient neurological deficit (TND) was seen in six out of 18 patients with IPM as opposed to all the patients (n=4) without IPM (p<0.02). Among the patients where injection pressure was monitored, six out of 198 patients developed TND when both USG and NS were used, compared to six out of 18 patients where only PNS was used (p<0.007).

Conclusion: Use of injection pressure monitoring along with different nerve localization techniques results in fewer transient neurological deficits.

Keywords: injection pressure monitoring; interscalene block; peripheral nerve stimulation; single shot brachial plexus block; supraclavicular block; transient neurological deficit; usg.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Multimodal approach for nerve localization and block administration.
Red arrow: ultrasound for nerve localization, white arrow: nerve stimulator, and black arrow: compressed air injection technique.
Figure 2
Figure 2. Demonstration of compressed air injection technique (CAIT).
While delivering the drug, 50% of an air column (5 ml) is compressed.
See this image and copyright information in PMC

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