Comparing the Effectiveness of Posterior Cord Stimulation With Medial Cord Stimulation in Infraclavicular Block for Forearm and Hand Surgeries Using Nerve Stimulator- A Randomised Controlled Trial

BACKGROUNDPeripheral nerve block remains a well-accepted component of comprehensive anaesthetic care and has extended role of analgesia and chronic pain management.Numerous modifications in techniques of infraclavicular brachial plexus block have been developed to improve success rate and decrease risk of complications.The aim of the study is to compare the effectiveness of blocking by stimulating posterior cord with the medial cord in infraclavicular block for forearm and hand surgeries using hand stimulator. MATERIALS AND METHODSThis randomised control trial included 62 patients of ASA I/II of either sex undergoing surgeries on elbow, forearm, hand.Patients were randomly allocated into two groups P and M, where the stimulation of posterior and medial cords are done respectively and effectiveness of sensory and motor components of upper limb block were assessed. RESULTSThe age, weight, gender, duration of surgery and surgical distribution and demographic profile were comparable in two groups.Sensory block in median/ulnar nerve with a p value of 0.718 is statistically insignificant in two groups.Sensory block of musculocutaneous nerve with P value of 0.001 is statistically significant, Sensory block of radial nerve with P value of 0.001 is statistically significant.Motor block in wrist with 93.5% in group P and 87.1% in group M is statistically insignificant (P-0.390).Motor block in elbow in group P is 96.8%, in group M is 45.2% and with P value of 0.001 is statistically significant.Complete sensory block in all 4 nerves is more with P group and is statistically significant (P 0.001).Complete motor block in all 3 joints is better in group P and is statistically significant (P 0.001).Effectiveness of surgical block with a P value of 0.002 is significant.Complication between two groups is not significant. CONCLUSIONFrom this study, it is inferred that nerve stimulator-guided posterior cord stimulation in infraclavicular block through coracoid approach has greatest extent and effectiveness of sensory/motor blockade compared to medial cord stimulation with similar rate of complications.