Ultrasound-guided vs landmark-guided techniques in brachial plexus block: A randomized controlled study

Abstract

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