Vol. 7, Issue 2, Part A (2025)

Background: Brachial plexus block (BPB) is a commonly used regional anesthesia technique for upper limb surgeries. Traditional landmark-guided (LMG) techniques rely on surface anatomy and eliciting paresthesia, while ultrasound-guided (USG) techniques allow real-time visualization of neural and vascular structures. This study compares the success rate, onset time, and complication profile of ultrasound-guided and landmark-guided approaches.
Methods: A prospective randomized controlled trial was conducted among 70 adult patients (ASA I-II) scheduled for upper limb surgeries under BPB. Patients were randomly assigned into two equal groups: Group U (Ultrasound-Guided, n=35) and Group L (Landmark-Guided, n=35). Both groups received a supraclavicular block with 30 mL of 0.5% bupivacaine. The primary outcomes were block success rate and onset time of sensory and motor block; secondary outcomes included complications and patient satisfaction.
Results: The success rate was 100% in the USG group versus 85.7% in the LMG group (p = 0.027). The mean onset time of sensory block was 8.5±2.1 min in the USG group compared to 13.2±3.7 min in the LMG group (p<0.001). Motor block onset was faster in the USG group (10.3±2.6 min) than in the LMG group (15.1±3.9 min, p<0.001). Complications such as vascular puncture and Horner’s syndrome occurred in 2.9% and 5.7% of LMG patients, respectively, and none in the USG group. Patient satisfaction was significantly higher in the USG group (p = 0.002).
Conclusion: Ultrasound guidance significantly improves block success, accelerates onset, and reduces complications compared to landmark techniques in brachial plexus block. Routine use of ultrasound guidance is recommended for safer and more effective regional anesthesia.