Ultrasound Guided Distal Peripheral Forearm Nerve Block for Hand and Wrist Surgeries
Keywords:
Ultrasound-guided nerve block, distal peripheral nerve block, axillary brachial plexus block, regional anaesthesia, hand surgery, forearm block, outpatient surgeryAbstract
Introduction: Hand and wrist surgeries are commonly performed as outpatient procedures, where regional anaesthesia is preferred for its ability to provide effective intraoperative anaesthesia and postoperative analgesia. Although the ultrasound-guided axillary brachial plexus block is a widely used technique, it is associated with longer onset times and a higher risk of complications. Alternatively, ultrasound-guided distal peripheral forearm nerve blocks have been proposed to improve efficiency and reduce procedure-related risks by targeting distal nerves while sparing proximal motor function. This study compares these two techniques in terms of efficiency, block success, and analgesic outcomes.
Materials & Methods: This observational superiority trial was conducted at Meenakshi Medical College Hospital & Research Institute, enrolling 100 adult patients undergoing elective hand and wrist surgeries. Patients were randomised to receive either an ultrasound-guided axillary brachial plexus block or a distal peripheral forearm nerve block. The primary outcome was total anaesthesia-related time. Secondary outcomes included surgical block success, pain scores (procedural and intraoperative), patient and surgeon satisfaction, and postoperative analgesia requirements.
Results: The distal block group demonstrated a significantly shorter total anaesthesia-related time (08:25 ± 04:01 min) compared to the axillary block group (12:31 ± 02:23 min, p=0.000). Both block performance and onset times were significantly shorter in the distal group (p=0.002 and p=0.000, respectively). While the distal block group had a higher complete block rate (86% vs. 78%, p=0.17), this was not statistically significant. Procedural pain was higher in the distal block group (p=0.02), but surgical incision pain was significantly lower (p=0.000). There were no significant differences in postoperative pain, operating room time, or satisfaction scores between groups.
Conclusion: Ultrasound-guided distal peripheral forearm nerve blocks offer a faster and equally effective alternative to axillary brachial plexus blocks for hand and wrist surgeries, with better intraoperative analgesia at the surgical site. This technique may enhance anaesthesia efficiency in ambulatory settings..
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Teunkens A, Vermeulen K, Belmans A, Degreef I, Van de Velde M, Rex S. Patient satisfaction with intravenous regional anaesthesia or an axillary block for minor ambulatory hand surgery: a randomised controlled study. Eur J Anaesthesiol. 2020;37:847-56.
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Jalil H, Polfliet F, Nijs K, et al. Efficacy of ultrasound-guided forearm nerve block versus forearm intravenous regional anaesthesia in patients undergoing carpal tunnel release: a randomized controlled trial. PLoS One. 2021;16:e0246863.
Soberón JR, Bhatt NR, Nossaman BD, Duncan SF, Patterson ME, Sisco-Wise LE. Distal peripheral nerve blockade for patients undergoing hand surgery: a pilot study. Hand (N Y). 2015;10(2):197-204.
Sehmbi H, Madjdpour C, Shah UJ, Chin KJ. Ultrasound guided distal peripheral nerve block of the upper limb: a technical review. J Anaesthesiol Clin Pharmacol. 2015;31(3):296-307.
Nijs K, Lismont A, De Wachter G, et al. The analgesic efficacy of forearm versus upper arm intravenous regional anesthesia (Bier’s block): a randomized controlled non-inferiority trial. J Clin Anesth. 2021;73:110329.
Teunkens A, Vermeulen K, Belmans A, Degreef I, Van de Velde M, Rex S. Patient satisfaction with intravenous regional anaesthesia or an axillary block for minor ambulatory hand surgery: a randomised controlled study. Eur J Anaesthesiol. 2020;37(9):847-56.
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