Baga, Leslie, BSN

Buxbaum, Jodie, MD

Cerrone, Mary Jane, MSN

Collins, J John, MD

Eid, Sherrine, MPH

Galassi, Joseph W, MD

Hartman, Dorothy, MD

He, Michael, MD

Hussain, Farheen, MS

Schwann, Nanette M, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of AnesthesiologyUltrasound Visualization vs. Electrical NerveStimulation for Interscalene and Axillary NerveBlock in Upper Extremity Surgery: A ProspectiveRandomized Trial (Poster)Joseph W. Galassi MDLehigh Valley Health Network, Joseph.Galassi@lvhn.orgJodie Buxbaum MDLehigh Valley Health Network, Jodie.Buxbaum@lvhn.orgJ John Collins MDLehigh Valley Health Network, John.Collins@lvhn.orgDorothy Hartman MDLehigh Valley Health Network, Dorothy.Hartman@lvhn.orgMichael He MDLehigh Valley Health Network, Michael.He@lvhn.orgSee next page for additional authorsFollow this and additional works at: https://scholarlyworks.lvhn.org/anesthesiologyPart of the Anesthesiology Commons, and the Surgery CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtGalassi, J., Buxbaum, J., Collins, J., Hartman, D., He, M., Hussain, F., Baga, L., Eid, S., Cerrone, M., & Schwann, N. (2010). Ultrasoundvisualization vs. electrical nerve stimulation for interscalene and axillary nerve block in upper extremity surgery: A prospective randomizedtrial. Poster presented at: The 12th Annual International Congress Cardiothoracic and Vascular Anesthesia, Beijing, China.Galassi, J. W., Buxbaum, J., Colins, J. J., Hartman, D., He, M. Hussain, F., Baga, L., Eid, S., Cerrone, M. J., Schwann, N. M. (2010, March20-23). Ultrasound Visualization vs. Electrical Nerve Stimulation for Interscalene and Axillary Nerve Block in Upper Extremity Surgery: AProspective Randomized Trial. Poster presented at: The International Anesthesia Research Society Annual Meeting, Honolulu, Hawaii.AuthorsJoseph W. Galassi MD, Jodie Buxbaum MD, J John Collins MD, Dorothy Hartman MD, Michael He MD,Farheen Hussain MS, Leslie Baga BSN, Sherrine Eid MPH, Mary Jane Cerrone MSN, and Nanette M.Schwann MDThis poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/anesthesiology/80Ultrasound Visualization vs. Electrical Nerve Stimulation for Interscalene and Axillary Nerve Block in Upper Extremity Surgery: A Prospective Randomized TrialIntroductionUltrasound can facilitate peripheral nerve blockade by providing visualization of nerves, surrounding structures, and the distribution of injected local anesthetic. Avoidance of electrical nerve stimulation and visualization of internal anatomy suggest that nerve blocks performed with ultrasound guidance (US) may require less time to perform and be associated with an improved patient experience. Provided that success rates are equivalent to those utilizing traditional nerve stimulation (NS), US may confer a distinct advantage for patient and provider. This randomized prospective trial compares US vs. NS with respect to block success rate, time for block completion, and patient comfort.MethodsAll patients over 18 years of age presenting for elective unilateral upper extremity surgery under isolated interscalene or axillary nerve block were screened. Patients with preexisting peripheral neuropathy, coagulopathy, local anesthetic allergy, or infection were excluded. After written informed consent was obtained, patients were randomized (1:1) to either US or NS techniques. A standardized pre-medication was used. NS was performed using a nerve stimulator attached to a 4 cm Stimuplex (B Braun) needle using twitches at a stimulus < 0.5 milliamps. US used a 13-6 MHz 25mm linear array probe and display monitor (L25e, S-Nerve, Sonosite). 40ccs of an equal mixture of 0.5% Bupivicaine/1.5% Mepivicaine with 1:200,000 of epinephrine were injected incrementally in both groups. Assessments of patient comfort were made immediately following the block, prior to surgery. Block failure was determined by the need for general anesthesia at any time during the procedure (intraoperative care team blinded to technique). Independent t tests were used to evaluate differences in mean scores between both groups.Results76 patients were enrolled. Overall, no statistically significant differences were seen between techniques in performance time, failure rates, block related complications, or overall patient experience (Table 1 & Table 2). However, there were statistically significant differences between groups with respect to comfort, pain, and anxiety experienced during the nerve block procedure (p=0.034, p=0.046, and p=0.027, respectively) (Table 3). Overall, patients in the NS group scored higher in pain and anxiety and lower in comfort than patients in the US group.DiscussionPractitioners are awaiting outcome data prior to investing in new techniques. Although effectiveness and safety are the primary endpoints of any nerve block, patient experience and provider time warrant evaluation. Procedure related discomfort creates a lasting impression and may affect patients’ future acceptance of regional anesthesia. Our data suggests that in comparison to NS, US is associated with less pain, anxiety, and improved patient comfort.Table 1. Total Needle TimeOutcome: Needle Time (minutes) Group N MeanStd. Deviation p-valueTotal Needle TimeNS 32 6.19 3.140.096US 44 4.99 3.01Fig. 1. Comparing Needle Time by GroupJW Galassi, MD;  J Buxbaum, MD; JJ Collins, MD; D Hartman, MD; M He, MD; F Hussain, MS; L Baga, BSN; S Eid, MPH; MJ Cerrone, MSN; NM Schwann, MDLehigh Valley Health Network, Allentown, Pennsylvania and Allentown Anesthesia Associates, Allentown, PennsylvaniaOutcome: Experience                   (1=worst, 5=best) Group N MeanStd. Deviation p-valueRate nerve block experienceNS 31 4.74 .510.737US 43 4.79 .68Overall anesthesia experienceNS 31 4.68 .600.367US 43 4.81 .66Rate surgical experienceNS 31 4.77 .430.301US 43 4.91 .61Outcome: Comfort                        (1=worst, 5=best) Group N MeanStd. Deviation p-valuePatient Comfort Index (PCI)NS 32 20.2 4.300.051US 44 21.8 2.15Were you anxious during the block procedure?*NS 32 2.8 1.40.370US 44 3.1 1.3Was the block procedure uncomfortable?**NS 32 3.2 1.10.034US 44 3.6 0.7Did the block procedure cause pain?**NS 32 3.4 1.10.046US 44 3.8 0.4Did you experience a funny bone sensation at any time during the block?NS 32 3.7 0.80.779US 44 3.6 0.7Did the nerve stimulation or US cause anxiety or pain?**NS 32 3.5 1.00.027US 44 4.05 0.2Did the injection of medicine cause anxiety or pain?*NS 32 3.6 0.90.542US 44 3.7 0.7Fig. 2. Comparing Experience by GroupFig. 3. Comparing Overall Comfort by Group Fig. 4. PCI Domain Scores by GroupTable 2. Overall Patient ExperienceTable 3. Assessments of Patient Comfort6 .194 .9901234567Total Needle TimeMinutes(min)N S U S4 .744 .684 .774 .794 .814 .911 2 3 4 5R ate N erve b lockE xperienceO vera ll anesthesiaE xperienceR ate surg ica lE xperienceScore (1=Worst, 5=Best)N S U S21.820.20 10 20 30P atien t C om fortIndex (P C I) S coreN S U S2.83.23.43.73.53.63.13.63.83.64.03.71 2 3 4 5Were you anxious duringthe block procedure?Was the block procedureuncomfortable?Did the block procedurecause pain?Did you experience a funnybone sensation at any timeduring the block?Did the nerve stimulation orUS cause anxiety or pain?Did the injection of medicinecause anxiety or pain?N S U S

Ultrasound Visualization vs. Electrical Nerve Stimulation for Interscalene and Axillary Nerve Block in Upper Extremity Surgery: A Prospective Randomized Trial (Poster)

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1109&context=anesthesiology

Ultrasound Visualization vs. Electrical Nerve Stimulation for Interscalene and Axillary Nerve Block in Upper Extremity Surgery: A Prospective Randomized Trial (Poster)

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