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

Abstract

Objective: 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. Materials and Methods: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. Results: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).Conclusions: Conscious hand surgery can be performed under distal nerve block anesthesia safely and successfully.Keywords: Distal nerve block, proximal nerve block, radial nerve, median nerve, brachial plexus ÖZ Amaç: Distal sinir blokları başarısız proksimal blok uygulamalarında tamamlayıcı blok olarak kullanılmaktadır. Bu çalışmanın primer amacı genel anestezi ve derin sedasyona ihtiyaç olmadan distal sinir bloklarının yeterli anestezi sağlayıp sağlamadığını değerlendirmektir. İkinci amacı ise blok uygulama ve blok gelişme zamanları, hasta ve cerrah memnuniyetlerini karşılaştırmaktır.Gereç ve Yöntem: 18-65 yaş, ASA I-III, Radial ve median sinir innervasyon alanlarını içeren elektif el cerrahisi geçirecek 34 hasta çalışmaya alındı ve hastalar randomize olarak infraklavikular blok grubu (Grup I, n=17) ve radial + median blok grubuna (Grup RM, n=17) dahil edildi. Blok uygulama ve blok gelişme zamanları ile hasta ve cerrah memnuniyetleri kayıt altına alındı.Bulgular: Genel anesteziye dönüş ve fentanil ihtiyacı olan hasta sayısı her iki grupta da aynıydı ve istatistiksel bir fark tespit edilmedi (p>0,05). Demografik veriler, ortalama cerrahi zamanı, turnike zamanı, blok uygulama zamanı, hasta ve cerrah memnuniyeti açısında gruplar arasında anlamlı bir istatistiksel fark yoktu (p>0,05). Blok gelişme zamanlarında ise gruplar arasında istatistiksel olarak anlamlı bir farklılık tespit edildi (p<0,05).Sonuç: Uyanık el cerrahisi distal sinir blokları ile güvenli ve başarılı bir şekilde uygulanabilir.Anahtar Kelimeler: Distal sinir bloğu, proks...

A randomized controlled trial evaluating the hemodynamic impact of ultrasound-guided great auricular nerve block in middle ear microsurgery

“…In this study, ultrasound-guided in-plane technique was used for GANB. Ultrasound-guided GANB has the advantages of ultrasound-guided technology, which is more accurate and effective with significantly reduced dosage of local anesthetic, less complications and less influence on the other adjacent nerves [6,19,20]. GAN is shallow in position and easy to access, we didn't find any neuropathic complication in this study.…”

“…It is more convenient and feasible to safely block a single distal nerve with a small dosage of local anesthetic. Thus, Ultrasound-guidance has the advantages of precise blocked area, accurate analgesic effect, and reduced side effects [ 4 – 6 ]. Scalp nerve block can blunt hemodynamic response to incision or get better hemodynamics in some neurosurgeries [ 7 , 8 ].…”

Efficacy of ultrasound-guided forearm nerve block versus forearm intravenous regional anaesthesia in patients undergoing carpal tunnel release: A randomized controlled trial

“…Ince et al . [ 15 ] demonstrated a success ratio of 100% after combined ultrasound-guided peripheral median and radial nerve block (superficial, sensory branch) for hand surgery, although they evaluated the success of the block using a cold sensation score. Soberon et al .…”

Ultrasound-guided Mid-humeral Radial Nerve Block Provides Sufficient Surgical Anesthesia at Hand Dorsum: A Novel Method and Report of Three Cases

“…The general advantages of distal peripheral nerve blocks could be expressed as: Distal approaches to upper extremity blocks need a lower amount of local anesthetic drugs with a blockade of a specific area. These approaches also avoid the risk of inadvertent puncture to critical structures, such as pleura or big vessels, which may occur when a proximal block is applied [ 3 , 5 ]. Distal peripheral nerve blocks allow the preservation of proximal muscle function of the upper limb and patients may be discharged earlier from the hospital [ 19 ].…”

“…Nowadays, US-guided regional blocks should be the first choice for such surgical procedures where the possible risks of general anesthesia and the necessity of clear airways are considered [ 4 ]. US-guided nerve blocks have many advantages, such as the avoidance of nerve damage, with a clear definition of nerves from the surrounding structures, control of the distribution of local anesthetics, visualization of needle position, faster block onset time, improved block qualities, and a reduction in the volumes of local anesthetics [ 5 - 6 ]. The success rate of regional anesthesia has increased when performed under ultrasound guidance.…”