Interscalene brachial plexus anaesthesia with small volumes of ropivacaine 0.75%: effects of the injection technique on the onset time of nerve blockade

Background and aim We evaluated the effect of the injection technique on the onset lime and efficacy of interscalene brachial plexus anaesthesia. Methods With Ethical Committee approval and written consent, 30 patients undergoing elective shoulder acromioplasty or capsuloplasty were randomly allocated to receive interscalene brachial plexus block with 20 mL of ropivacaine 0.75% by using either a single injection (Single group, n=15) or multiple injection (Multiple group, n=15). Nerve blocks were placed with the aid of a nerve stimulator using short bevelled, Teflon(R) coated needles. The stimulation frequency was set at 2 Hz and the intensity of stimulating current, initially set at 1 mA, was gradually decreased to less than or equal to0.5 mA after each muscular twitch was observed. In the Single group, the anaesthetic solution was slowly injected after the first muscular twitch had been observed. In the Multiple group, 8 mL were injected at shoulder abduction, 6 mL were injected at arm flexion, and 6mL at the extension of the arm. Results Placing the block required 5 min (4-8 min) in the Multiple group and 3 min (1-10 min) in the Single group (P=0.001); however, total preoperative time (from skin disinfection to complete loss of pinprick sensation from C-4 to C-7 with inability to elevate the limb from the operating table) was shorter in the Multiple group (15 min; range 10-28 min) than in the Single group (23 min; range 14-60 min) (P=0.03). Additional intravenous fentanyl supplementation was required in two patients of the Multiple group (13%) and eight patients of the Single group (53%) (P=0.05). Conclusion We conclude that using a multiple injection technique shortened the preparation time and improved the quality of interscalene brachial plexus anaesthesia performed with small volumes of ropivacaine 0.75%.