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

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.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0584-7) contains supplementary material, which is available to authorized users.

Anestesia regional en procedimientos ortopédicos electivos

“…There is no difference in terms of the duration of sensory block, post-operative analgesic effect, or duration of motor block in the shoulder when comparing axillary nerve block to distal PNBs 30 . The quality and efficacy of BSC is higher when using ultrasound instead of a neurostimulator 31 .…”

Wide-Awake Approach for Terrible Triad Injury Fixation: A Report of Two Cases

“…The addition of ultrasound-guided anesthetic injections such as the “elbow plexus block” described by Diwan and Nair can be added to provide adequate anesthesia for the elbow joint capsule while still retaining motor function. 9 , 10 The second case had shoulder stiffness because of the delayed surgical treatment, which again is not addressed by the local anesthetic injection.…”

A comparison between axillary brachial plexus block and elbow block using ultrasound in patients undergoing surgeries of wrist and hand

“…There is paucity of the literature that has studied the US-guided selective nerve block at elbow. Elbow block has been found to be safe and acceptable primary anesthetic technique compared with axillary 7,8 and infraclavicular. 9 All the three studies [7][8][9] focusing comparison of axillary block with blocks at or around elbow were performed in the population abroad.…”

“…Elbow block has been found to be safe and acceptable primary anesthetic technique compared with axillary 7,8 and infraclavicular. 9 All the three studies [7][8][9] focusing comparison of axillary block with blocks at or around elbow were performed in the population abroad. To the horizon of our knowledge, no study has yet been performed in Indian context to compare US-guided axillary brachial plexus block and elbow block in patients undergoing surgeries of wrist and hand.…”