Two-Stage and Two-Component Brachial Plexus Block in Trauma Patients

M.L. Homon


Objective. To improve the quality of anesthetic management in trauma surgeries on upper extremity using two-component and two-stage block under the guidance of neurostimulator of different parts of the brachial plexus. Materials and Methods. Comparison of brachial plexus blockade using supraclavicular approaches in 54 trauma patients has been carried out. In the control group (n = 27), we have used a single-step anesthetic supply at a dose of 20 ml of 1.5% lidocaine with traces of adrenaline and 20 ml of 0.5% bupivacaine when identifying the plexus by neurostimulator. In the experimental group (n = 27), we have used a two-stage and two-component anesthetic supply. In this case, 20 ml of 0.5% bupivacaine were injected to the trunk that innervates future site of operative wound, which was determined by neurostimulator; in another part of the plexus we have injected 20 ml of 1.5% lidocaine to provide complete muscle relaxation. The quality of anesthesia was assessed by hemodynamic stability, frequency of additional use of sedatives and analgesics, duration of motor and sensory block. Results and Discussion. It is found that multimodal two-component and two-stage technique of brachial plexus blockade using supraclavicular approach was characterized by stable hemodynamics without episodes of hypertension, reduced frequency of additional use of sedative and analgesic therapy, a lower incidence of cases of transition to general anesthesia, clear terms and longer duration of motor and sensory block, absence of early complications that makes it possible to speak of a more effective antinociceptive protection during surgery on upper extremity compared with the traditional one-stage brachial plexus block with a similar dose of anesthetic.
Conclusions. Two-component and two-stage technique of brachial plexus blockade using supraclavicular approach during surgeries on upper extermity in traumatology provided a better protection from pain syndrome compared with one-stage introduction of a similar dose of local anesthetic. The applied methodology provided a sufficient depth of anesthesia that has been associated with a stable hemodynamics, lower frequency of additional use of sedatives and narcotic analgesics during surgery, a longer period of postoperative analgesia compared with the use of a similar dose of local anesthetic simultaneously.


two-stage and two-component brachial plexus block; trauma intervention on the upper extremity


Коломаченко В.І., Чубенко О.В., Петюнін Г.П. Плазмові рівні лідокаїну у ортопедичних пацієнтів після блокад нервів нижньої кінцівки // Український журнал клінічної та лабораторної медицини. — 2010. — № 3. — С. 145-148.

Мaйер Г., Бютнер Й. Периферическая регионарная анестезия: Атлас / [пер. с англ. под ред. П.Р. Камчатнова]. — М.: Бином. Лаборатория знаний, 2010. — 260 с.

Рафмелл Д.П., Нил Д.Н., Вискоуми К.М. Регионарная анестезия. — М.: МЕДпресс-информ, 2013. — 272 с.

Сафронов Н.Ф. Анестезиологическое обеспечение операций на верхней конечности при политравме. — 2011.

Строкань А.М., Шлапак І.П. Периферична реґіонарна анестезія. — К., 2014. — 142 с.

Тарабрин О.А. Регионарная анестезия. Том 1. Верхняя конечность / О.А. Тарабрин. — СПб., 2010. — 253 с.

Фесенко В.С. Модифікований доступ для безпечної міждрабинчастої блокади // Біль, знеболювання та інтенсивна терапія. — 2007. — № 3. — С. 6-11

Фесенко В.С. Интоксикация местными анестетиками: старая опасность, современные мифы, новые препараты и «серебряная пуля» // Біль, знеболювання та інтенсивна терапія. — 2009. — № 3. — С. 2-10.

Фесенко В.С. Поширеність блокади після анестезії плечового сплетення різними доступами // Ортопедия, травматология и протезирование. — 2009. — № 1. — С. 92-96.

Arbona L. Fernando, Khabiri Babak, Norton John A. Ultrasound-Guided Regional Anesthesia: A Practical Approach to Peri­pheral Nerve Blocks and Perineural Catheters. — Cambridge: University Press, 2011. — 194 р.

Boezaart Andre P. Atlas of Peripheral Nerve Blocks and Ana­tomy for Orthopaedic Anesthesia with DVD, 1e (The Atlases of Anesthesia Techniques Series) // Saunders; 1 Har/DVD edition (December 10, 2007), book № 3. — Р. 1-62.

Didier A. Sciard, Matuszczak E.Maria. Landmarks for Peripheral Nerve Blocks: Upper and Lower Extremities. — Lippincott Williams & Wilkins, 2011. — Р. 2-31.

Fuzier R., Tissot B. Evaluation of regional anesthesia procedure in an emergency department // Annales françaises d’anesthesie et de reanimation. — 2002. — Vol. 21, № 3. — P. 193-197.

Hopkins P. Ultrasound guidance as a gold standard in regional anaesthesia // British Journal of Anaesthesia. — 2007. — 98 (3). — 299-301.

Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia // Br. J. Anaesth. — 2005. — 94. — 7-17.

Movafegh Ali, Razazian Mehran. Dexamethasone Added to Lidocaine Prolongs Aхillary Brachial Plexus Blockade // Anesth. Analg. — 2006. — 102. — Р. 263-267.



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