BACKGROUND: Data are limited regarding the use of peripheral nerve blockade at the level of the forearm, and most studies regard these procedures as rescue techniques for failed or incomplete blocks. The purpose of the study was to investigate patients undergoing hand surgery with distal peripheral nerve (forearm) blocks and compare them with patients having similar procedures under more proximal brachial plexus blockade. No investigations comparing distal nerve blockade to proximal approaches are currently reported in the literature. METHODS: Medical records were retrospectively reviewed for patients who had undergone hand surgery with a peripheral nerve block between November 2012 and October 2013. The primary outcome was the ability to provide a primary anesthetic without the need for general anesthesia or local anesthetic supplementation by the surgical team. Secondary outcome measures included narcotic administration during the block and intraoperative procedures, block performance times, and the need for rescue analgesics in the post anesthesia care unit (PACU). RESULTS: No statistical difference in conversion rates to general anesthesia was observed between the two groups. Total opiate administration for the block and surgical procedure was lower in the forearm block group. There was no difference in block performance times or need for rescue analgesics in the PACU. CONCLUSIONS: Forearm blocks are viable alternatives to proximal blockade and are effective as a primary anesthetic technique in patients undergoing hand surgery. Compared to the more proximal approaches, these blocks have the benefits of not causing respiratory compromise, the ability to be performed bilaterally, and may be safer in anticoagulated patients.
BACKGROUND: Data are limited regarding the use of peripheral nerve blockade at the level of the forearm, and most studies regard these procedures as rescue techniques for failed or incomplete blocks. The purpose of the study was to investigate patients undergoing hand surgery with distal peripheral nerve (forearm) blocks and compare them with patients having similar procedures under more proximal brachial plexus blockade. No investigations comparing distal nerve blockade to proximal approaches are currently reported in the literature. METHODS: Medical records were retrospectively reviewed for patients who had undergone hand surgery with a peripheral nerve block between November 2012 and October 2013. The primary outcome was the ability to provide a primary anesthetic without the need for general anesthesia or local anesthetic supplementation by the surgical team. Secondary outcome measures included narcotic administration during the block and intraoperative procedures, block performance times, and the need for rescue analgesics in the post anesthesia care unit (PACU). RESULTS: No statistical difference in conversion rates to general anesthesia was observed between the two groups. Total opiate administration for the block and surgical procedure was lower in the forearm block group. There was no difference in block performance times or need for rescue analgesics in the PACU. CONCLUSIONS: Forearm blocks are viable alternatives to proximal blockade and are effective as a primary anesthetic technique in patients undergoing hand surgery. Compared to the more proximal approaches, these blocks have the benefits of not causing respiratory compromise, the ability to be performed bilaterally, and may be safer in anticoagulated patients.
Entities:
Keywords:
Forearm blocks; Hand surgery; Median (or) ulnar (or) radial nerve blocks; Regional anesthesia; Ultrasound-guided
Authors: Colin J L McCartney; Daquan Xu; Corina Constantinescu; Sherif Abbas; Vincent W S Chan Journal: Reg Anesth Pain Med Date: 2007 Sep-Oct Impact factor: 6.288
Authors: Arry Kathirgamanathan; James French; Gillian L Foxall; Jonathan G Hardman; Nigel M Bedforth Journal: Eur J Anaesthesiol Date: 2009-01 Impact factor: 4.330
Authors: S Anagnostopoulou; T Saranteas; C Chantzi; V Dimitriou; A Karabinis; G Kostopanagiotou Journal: Anaesth Intensive Care Date: 2008-05 Impact factor: 1.669
Authors: Otto Liebmann; Daniel Price; Chris Mills; Rebekah Gardner; Ralph Wang; Sharon Wilson; Andrew Gray Journal: Ann Emerg Med Date: 2006-06-14 Impact factor: 5.721
Authors: Hassanin Jalil; Florence Polfliet; Kristof Nijs; Liesbeth Bruckers; Gerrit De Wachter; Ina Callebaut; Lene Salimans; Marc Van de Velde; Björn Stessel Journal: PLoS One Date: 2021-02-19 Impact factor: 3.240