A comparison between axillary brachial plexus block and peripheral nerve block of five nerves around the elbow using ultrasound in patients undergoing surgeries of the wrist, hand and distal forearm : a randomised single-blind trial

The topic of my thesis is a comparison between Axillary brachial plexus block and peripheral nerve block of 5 nerves around the elbow using ultrasound in patients undergoing surgeries of the wrist, hand and distal forearm, a randomised single blind trial. Axillary brachial plexus block is associated with prolonged motor paralysis at the elbow and digits and a chance of inadvertent arterial puncture. Peripheral nerve blocks around the elbow preserves motor function, improves mobility at the elbow improving patient satisfaction. There is no study with blocks of Lateral and Medial antebrachial cutaneous nerves along with Radial,Ulnar and Median nerve blocks. Primary objective is to compare the quality and duration of the motor blockade of elbow, wrist joint and fingers. The secondary objective is to compare the onset of action and duration of sensory blockade, duration of post operative analgesia, total opioid requirement for 24 hour post operative period, time taken for the procedure, percentage conversion to general anaesthesia. The total sample size of the study is 102. Blocks will be performed by an anaesthesiologist who had previously done 25 or more axillary brachial plexus blocks and individual peripheral nerve blocks before the commencement of study. Assessment will be done at a 5 minute interval till 30 minutes. Motor block will be assessed for flexion and extension of the elbow, wrist and finger flexion and opponens of the thumb. Sensory block will be assessed every 2 minutes for 30 minutes for loss of pinprick discrimination. Block is deemed as incomplete if patient feels pain at the end of 30 minutes and GA will be instituted. Post operative VAS scores and time of rescue analgesic will be noted. Data recording will be done using MS excel. Demographic statistics for continuous variables will be represented as Mean and that for categorical variables will be represented as frequency. Informed consent will be obtained, information of all participants will be kept confidential. There will be no additional financial implication.