17. Ultrasound-guided Supraclavicular Block (USGB) by Surgeon for ORIF of Distal Radius Fractures (DRF): A 6-year Experience with 1830 Consecutive Cases

Abstract

PURPOSE: Anesthesiologist need for preoperative testing for distal radius (DRF) ORIF delays care and increases costs. Familiar with ultrasound and anatomy, surgeons are well poised to deliver ultrasound guided supraclavicular block (UGSB.) We reviewed our experience with surgeon delivered UGSB without anesthesiologists to assess its safety and efficacy. METHODS: We retrospectively reviewed all DRFsORIF performed at our ASC by 3 surgeons over a 6-year period. Operative data, complications, demographics, clinical characteristics, fracture patterns, and functional outcomes were evaluated. RESULTS: 1,830 consecutive patients underwent ORIF without anesthesiologists; 1123 females, 707 males, age 62years (27-97). Six bilateral fractures. Fracture types: 783(A), 244(B) and 704(C); with 9 Gustilo(I), 4 Gustilo(II), and 92 malunions. Thirty-two distal ulnar fractures also required ORIF. 1,410 patients were ASA2, and 420 ASA3. Average time to administer block was 5.5min, tourniquet time 24.5min, and 63min total time patient spent in facility. Patients received no IV’s, self-ambulated to and from the OR table pain free, and conversed with the sitter nurse thru the procedure. 82 patients had partial UGSB failure requiring local lidocaine supplementation. No block related complications occurred except two transient unilateral phrenic nerve palsy. There were no infections, no hematomas and postoperatively required only 15 narcotic pills on the average (50% of historical). Upon discharge, 1,551 patients achieved normal range-of-motion, and 5 developed CRPS. Patient easily tolerated surgery without anesthesiologists and were highly satisfied with the expedited care and outcome. CONCLUSION: ORIF of DRFs can be safely, expeditiously, successfully, and cost-effectively treated by surgeon delivered UGSB without anesthesiologists and extensive preoperative testing.