The ultrasound-guided selective nerve block in the upper arm: an approach of retaining the motor function in elbow

Weijuan Zhu,Yun Xia,Xuzhong Xu,Thomas J Papadimos,Lvdan Huang,Lulu Chen,Riyong Zhou,Yuanqing Chen

doi:10.1186/s12871-018-0584-7

Abstract

BackgroundProximal brachial plexus blocks can lead to an extended period of motor paralysis and delay the return of motor function. This could influence patient satisfaction, and extend hospitalizations. The aim of the study is to compare a selective distal nerve block of the arm to a proximal axillary block, both ultrasound-guided, in terms of their motor block intensity of the elbow. Our hypothesis is that a selective nerve block of the arm would result in a different motor block of the elbow, compared to the axillary block.MethodsA sample size of 24 patients who were undergoing elective surgery (ASA I-III) of the wrist, hand or forearm was randomly divided into two groups: Arm Group (n = 12) and Axillary Group (n = 12). The Arm Group received ultrasound-guided block of the median, ulnar, and medial antebrachial cutaneous nerves at the level of upper-median 1/3 of the arm, and a block of the radial and musculocutaneous nerves at the level of low-median 1/3 of the arm, while the Axillary Group received ultrasound-guided axillary brachial plexus blocks. Both blocks used in combination with general anesthesia.ResultsOur results demonstrated that the incidence of motor block at the elbow in the Arm Group was lower than in the Axillary Group. Compared with the Axillary Group, the duration of motor block at the elbow and the onset time of sensory block in the Arm Group were shortened. The patient satisfaction was increased in the Arm Group. There were no differences in the duration of the sensory block, the effect on postoperative analgesia, or in the duration of the motor block at the shoulder between both groups.ConclusionOur study showed that ultrasound-guided selective nerve block in the upper arm allowed improved retention of motor function at the elbow compared to axillary block. Secondarily, the ultrasound-guided selective nerve block seemed to provide similar analgesia after surgery of the hand or forearm with an enhanced patient satisfaction.Trial registrationChinese Clinical Trial Registry, ChiCTR-IOR-16008769. Registered 3 July 2016.

Highlights

Proximal brachial plexus blocks can lead to an extended period of motor paralysis and delay the return of motor function
There were no differences in the duration of sensory block [540(540,585) vs. 600(540,735), P = 0.157] and the duration of motor block of the shoulder [0(0,0) vs. 0(0,0), P = 1] between both groups (Table 2)
Our study showed that the selective distal ultrasound-guided block of the arm with a volume of 25 ml of ropivacaine preserves the motor function of the elbow, compared with an axillary ultrasound block by the same anesthetic agent

Summary

Introduction

Proximal brachial plexus blocks can lead to an extended period of motor paralysis and delay the return of motor function. This could influence patient satisfaction, and extend hospitalizations. The aim of the study is to compare a selective distal nerve block of the arm to a proximal axillary block, both ultrasound-guided, in terms of their motor block intensity of the elbow. Our hypothesis is that a selective nerve block of the arm would result in a different motor block of the elbow, compared to the axillary block. Interscalene, supraclavicular, axillary and infraclavicular approaches to brachial plexus blockade provide effective anesthesia for surgical procedures [1]. Proximal brachial plexus blocks may lead to a prolonged period of motor paralysis, i.e. There has been no technique reported far that provides both effective analgesia and motor function at the elbow and shoulder during upper limb surgery below the elbow

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