Can We Perform Distal Nerve Block Instead of Brachial Plexus Nerve Block Under Ultrasound Guidance for Hand Surgery?

Ilker Ince,Mehmet Aksoy,Mine Celik

doi:10.5152/eurasianjmed.2016.0256

Abstract

Distal nerve blocks are used in the event of unsuccessful blocks as rescue techniques. The primary purpose of this study was to determine the sufficiency for anesthesia of distal nerve block without the need for deep sedation or general anesthesia. The secondary purpose was to compare block performance times, block onset times, and patient and surgeon satisfaction. Patients who underwent hand surgery associated with the innervation area of the radial and median nerves were included in the study. Thirty-four patients who were 18-65 years old and American Society of Anesthesiologists grade I-III and who were scheduled for elective hand surgery under conscious nerve block anesthesia were randomly included in an infraclavicular block group (Group I, n=17) or a radial plus median block group (Group RM, n=17). The block performance time, block onset time, satisfaction of the patient and surgeon, and number of fentanyl administrations were recorded. The numbers of patients who needed fentanyl administration and conversion to general anesthesia were the same in Group I and Group RM and there was no statistically significant difference (p>0.05). The demographics, surgery times, tourniquet times, block perfomance times, and patient and surgeon satisfaction of the groups were similar and there were no statistically significant differences (p>0.05). There was a statistically significant difference in block onset times between the groups (p<0.05). Conscious hand surgery can be performed under distal nerve block anesthesia safely and successfully.

Highlights

Ultrasound (US)-guided regional anesthesia is a common anesthetic technique for patients undergoing hand surgery [1]
Conscious hand surgery can be performed under distal nerve block anesthesia safely and successfully
The US probe was placed on the marked area of skin of the forearm, the needle was inserted and advanced from the lateral to the medial side toward the radial nerve using an in-plane technique, and 5 mL local anesthetic was injected around the radial nerve

Summary

Introduction

Ultrasound (US)-guided regional anesthesia is a common anesthetic technique for patients undergoing hand surgery [1]. There are different proximal approaches to peripheral nerve blocks such as axillary, infraclavicular, supraclavicular, and interscalene brachial plexus nerve blocks. Peripheral nerve block of the distal nerves of the brachial plexus, namely, the radial, median, and ulnar nerves, under US guidance has been performed as a rescue block in the. 168 Ince et al Distal Nerve Block or Brachial Plexus Block?. A few studies have presented distal nerve blocks as a primary anesthetic technique [4, 5]. We hypothesized that hand surgery can be performed under distal peripheral nerve block with US guidance. The aim of this study was to evaluate the sufficiency of US-guided distal peripheral nerve block for hand surgery as a primary anesthetic technique

Methods

Results

Discussion

Conclusion