Journal on Recent Advances in Pain

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VOLUME 5 , ISSUE 3 ( September-December, 2019 ) > List of Articles

Original Article

Acceptance of Transverse Sweep vs Backtracking Method for Ultrasound-guided Interscalene Block in Awake Patients

Jayashree Venkatesan, J Balavenkatsubramanian

Keywords : Backtracking, Interscalene block, Pain, Transverse sweep

Citation Information : Venkatesan J, Balavenkatsubramanian J. Acceptance of Transverse Sweep vs Backtracking Method for Ultrasound-guided Interscalene Block in Awake Patients. J Recent Adv Pain 2019; 5 (3):75-77.

DOI: 10.5005/jp-journals-10046-0151

License: CC BY-NC 4.0

Published Online: 21-07-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Background: Ultrasound-guided interscalene block is widely practiced for upper extremity surgery. There are two methods of identifying the brachial plexus by interscalene method—transverse sweep and backtracking. These methods are also used to scan stellate ganglion and do interventional procedure for Complex Regional Pain Syndrome 1 (CRPS1) and Complex Regional Pain Syndrome 2 (CRPS2). The aim of this study was to compare the two methods in an awake patient, the level of patient’s comfort, acceptance, and presence of any symptoms like coughing, choking, vomiting, dyspnea, and pain. Materials and methods: In total, 100 patients undergoing upper extremity surgery requiring interscalene block were scanned with SonoSite Edge, high-frequency linear probe (6–13 Hz) by both the transverse and backtracking methods. All patients were subjected to both the methods of scanning, and the level of patient’s comfort was compared. We categorized the comfort level into three levels—comfortable, mild discomfort, and significant discomfort. We measured pain with the help of unidirectional verbal rating scale as no pain, mild, moderate, and severe. Also, we recorded the associated symptoms including choking sensation, nausea, vomiting, cough, and dyspnea. Results: Even though the number of events was smaller in number in the transverse sweep method, the backtracking method scored over the transverse method. The transverse method caused some percentage of nausea (4%), choking (12%), dyspnea (6%), and mild pain (12%) and was statistically worse than the backtracking method. Although the comfort levels were not comparable statistically, due to lack of sufficient subgroups, transverse sweep patients had discomfort ranging from mild to significant compared with the comfortable feeling reported by all, when the backtracking method was used. Conclusion: The acceptance of the backtracking method was better than the transverse sweep method while scanning for ultrasound-guided block in awake patients.

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  1. Wu JJ, Lollo L, Grabinsky A. Regional anesthesia in trauma medicine. Anesthesiol Res Pract 2011;2011:713281. DOI: 10.1155/2011/713281, Review Article.
  2. Malchow RJ, Black IH. The evolution of pain management in the critically ill trauma patient: emerging concepts from the global war on terrorism. Critical Care Medicine, 2008;36(Suppl 7):pp. S346–S357. DOI: 10.1097/CCM.0b013e31817e2fc9.
  3. Bernards CM, Hadzic A, Suresh S, et al. Regional anesthesia in anesthetized or heavily sedated patients. Reg Anesth Pain Med 2008;33(5):449–460. DOI: 10.1097/00115550-200809000-00008.
  4. Dr Joseph Carter, Dr Ajit Bhat, Department of Anaesthesia, Queen Elizabeth Hospital, King’s Lynn. Ultrasound guided interscalene brachial plexus block anaesthesia tutorial of the week-233, 25th July 2011.
  5. Dr T Balasubramanian. Applied anatomy of recurrent laryngeal nerve online.
  6. Dr John Doyle, Anesthesia for Ear, Nose and Throat Surgery, Millers anesthesia 8th edition.
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