Comparison of the anesthetic effect of ultrasound-guided brachial plexus block by different approaches in distal radius surgery

Abstract

Objective To compare the anaesthetic effect of ultrasound-guided brachial plexus block by different approaches (interscalene, axillary, supraclavicular) in distal radius surgery. Methods Ninety adult patients undergoing elective surgery for distal radius fracture open reduction and internal fixation, distal radius fracture after implant removal surgery distal radius fracture, were randomly divided into interscalene group(group A), axillary group(group B) and supraclavicular group (group C) for brachial plexus block under ultrasound-guided(n=30). The performance time and complications were recorded. Besides, the onset time and block execution time of median nerve, ulnar nerve, radial nerve, lateral medial cutaneous nerve, forearm medial cutaneous nerve were evaluated. Results There is no significant difference in performance time(P>0.05) and the onset time of pain block in median nerve, radial nerve, lateral medial cutaneous nerve (P>0.05). As for ulnar nerve and medial antebrachial cutaneous nerve, there were no difference in onset time of pain block between group A[(21±6) min] and group C[(20±5) min] (P>0.05), but they were longer than group B[(8±5) min] (P 0.05), but they were longer than group B[(10±6) min] (P<0.05). The complete suceess rate of group B(90%) were higher than other two groups. We found that two patients in group A and one patient in group C were complicated with phrenic nerve block and one patient in group B showed little tolerance of tourniquet. Conclusions Ultrasound-guided axillary brachial plexus block in the distal radius surgery is recommended because of better blockage of ulnar nerve and medial antebrachial cutaneous nerve and fewer complications. Key words: Ultrasound; Brachial plexus block; Distal radius