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


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