A Triple-Masked, Randomized Controlled Trial Comparing Ultrasound-Guided Brachial Plexus and Distal Peripheral Nerve Block Anesthesia for Outpatient Hand Surgery
Background. For hand surgery, brachial plexus blocks provide effective anesthesia but produce undesirable numbness. We hypothesized that distal peripheral nerve blocks will better preserve motor function while providing effective anesthesia. Methods. Adult subjects who were scheduled for elective a...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Anesthesiology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2014/324083 |
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| author | Nicholas C. K. Lam Matthew Charles Deana Mercer Codruta Soneru Jennifer Dillow Francisco Jaime Timothy R. Petersen Edward R. Mariano |
| author_facet | Nicholas C. K. Lam Matthew Charles Deana Mercer Codruta Soneru Jennifer Dillow Francisco Jaime Timothy R. Petersen Edward R. Mariano |
| author_sort | Nicholas C. K. Lam |
| collection | DOAJ |
| description | Background. For hand surgery, brachial plexus blocks provide effective anesthesia but produce undesirable numbness. We hypothesized that distal peripheral nerve blocks will better preserve motor function while providing effective anesthesia. Methods. Adult subjects who were scheduled for elective ambulatory hand surgery under regional anesthesia and sedation were recruited and randomly assigned to receive ultrasound-guided supraclavicular brachial plexus block or distal block of the ulnar and median nerves. Each subject received 15 mL of 1.5% mepivacaine at the assigned location with 15 mL of normal saline injected in the alternate block location. The primary outcome (change in baseline grip strength measured by a hydraulic dynamometer) was tested before the block and prior to discharge. Subject satisfaction data were collected the day after surgery. Results. Fourteen subjects were enrolled. Median (interquartile range [IQR]) strength loss in the distal group was 21.4% (14.3, 47.8%), while all subjects in the supraclavicular group lost 100% of their preoperative strength, P = 0.001. Subjects in the distal group reported greater satisfaction with their block procedures on the day after surgery, P = 0.012. Conclusion. Distal nerve blocks better preserve motor function without negatively affecting quality of anesthesia, leading to increased patient satisfaction, when compared to brachial plexus block. |
| format | Article |
| id | doaj-art-69802a1bc7404ed48c80d96d5886bbaa |
| institution | Kabale University |
| issn | 1687-6962 1687-6970 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Anesthesiology Research and Practice |
| spelling | doaj-art-69802a1bc7404ed48c80d96d5886bbaa2025-02-03T05:51:44ZengWileyAnesthesiology Research and Practice1687-69621687-69702014-01-01201410.1155/2014/324083324083A Triple-Masked, Randomized Controlled Trial Comparing Ultrasound-Guided Brachial Plexus and Distal Peripheral Nerve Block Anesthesia for Outpatient Hand SurgeryNicholas C. K. Lam0Matthew Charles1Deana Mercer2Codruta Soneru3Jennifer Dillow4Francisco Jaime5Timothy R. Petersen6Edward R. Mariano7Department of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, NM 87131, USADepartment of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, NM 87131, USADepartment of Orthopaedics & Rehabilitation, University of New Mexico, Albuquerque, NM 87131, USADepartment of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, NM 87131, USADepartment of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, NM 87131, USADepartment of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, NM 87131, USADepartment of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, NM 87131, USADepartment of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USABackground. For hand surgery, brachial plexus blocks provide effective anesthesia but produce undesirable numbness. We hypothesized that distal peripheral nerve blocks will better preserve motor function while providing effective anesthesia. Methods. Adult subjects who were scheduled for elective ambulatory hand surgery under regional anesthesia and sedation were recruited and randomly assigned to receive ultrasound-guided supraclavicular brachial plexus block or distal block of the ulnar and median nerves. Each subject received 15 mL of 1.5% mepivacaine at the assigned location with 15 mL of normal saline injected in the alternate block location. The primary outcome (change in baseline grip strength measured by a hydraulic dynamometer) was tested before the block and prior to discharge. Subject satisfaction data were collected the day after surgery. Results. Fourteen subjects were enrolled. Median (interquartile range [IQR]) strength loss in the distal group was 21.4% (14.3, 47.8%), while all subjects in the supraclavicular group lost 100% of their preoperative strength, P = 0.001. Subjects in the distal group reported greater satisfaction with their block procedures on the day after surgery, P = 0.012. Conclusion. Distal nerve blocks better preserve motor function without negatively affecting quality of anesthesia, leading to increased patient satisfaction, when compared to brachial plexus block.http://dx.doi.org/10.1155/2014/324083 |
| spellingShingle | Nicholas C. K. Lam Matthew Charles Deana Mercer Codruta Soneru Jennifer Dillow Francisco Jaime Timothy R. Petersen Edward R. Mariano A Triple-Masked, Randomized Controlled Trial Comparing Ultrasound-Guided Brachial Plexus and Distal Peripheral Nerve Block Anesthesia for Outpatient Hand Surgery Anesthesiology Research and Practice |
| title | A Triple-Masked, Randomized Controlled Trial Comparing Ultrasound-Guided Brachial Plexus and Distal Peripheral Nerve Block Anesthesia for Outpatient Hand Surgery |
| title_full | A Triple-Masked, Randomized Controlled Trial Comparing Ultrasound-Guided Brachial Plexus and Distal Peripheral Nerve Block Anesthesia for Outpatient Hand Surgery |
| title_fullStr | A Triple-Masked, Randomized Controlled Trial Comparing Ultrasound-Guided Brachial Plexus and Distal Peripheral Nerve Block Anesthesia for Outpatient Hand Surgery |
| title_full_unstemmed | A Triple-Masked, Randomized Controlled Trial Comparing Ultrasound-Guided Brachial Plexus and Distal Peripheral Nerve Block Anesthesia for Outpatient Hand Surgery |
| title_short | A Triple-Masked, Randomized Controlled Trial Comparing Ultrasound-Guided Brachial Plexus and Distal Peripheral Nerve Block Anesthesia for Outpatient Hand Surgery |
| title_sort | triple masked randomized controlled trial comparing ultrasound guided brachial plexus and distal peripheral nerve block anesthesia for outpatient hand surgery |
| url | http://dx.doi.org/10.1155/2014/324083 |
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