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. 2016 Oct;48(3):167-171.
doi: 10.5152/eurasianjmed.2016.0256.

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

Ilker Ince  1 , Mehmet Aksoy  1 , Mine Celik  1
Affiliations

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

Ilker Ince et al. Eurasian J Med. 2016 Oct.

Abstract
in English, Turkish

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.

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.

Keywords: Distal nerve block; brachial plexus; median nerve; proximal nerve block; radial nerve.

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Conflict of interest statement

No conflict of interest was declared by the authors.

Figures

Figure 1.
Figure 1.
Simultaneous visualization of the radial and median nerves on an ultrasound screen.
Figure 2.
Figure 2.
Position of radial nerve, median nerve, and needle.
Figure 3.
Figure 3.
Esmarch bandage on forearm.
Figure 4.
Figure 4.
Consolidated Standards of Reporting Trials (CONSORT) flow diagram of patient distribution.
See this image and copyright information in PMC

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