Abstract
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.
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Acknowledgments
We would like to thank the Ochsner Clinic Foundation Publishing Services team and Dr. Lauren D. Vazquez for proofreading this submission. We also thank Barbara Siede, MS, from the Ochsner Clinic Foundation Medical Illustration Services for her assistance in the labeling of our images.
Conflict of Interest
José R. Soberón, Jr. received research funding from Pacira Pharmaceuticals (Parsippany, NJ). His institution received an unrestricted research grant from Pacira Pharmaceuticals in 2013. It was not used to fund this investigation, and Pacira Pharmaceuticals’ products and services are not discussed in this manuscript.
Neil R. Bhatt reported no conflicts of interest.
Bobby D. Nossaman reported no conflicts of interest.
Scott F. Duncan reported no conflicts of interest.
Matthew E. Patterson reported no conflicts of interest.
Leslie E. Sisco-Wise reported no conflicts of interest.
José R. Soberón, Jr. had seen the original study data, reviewed the analysis of the data, approved the final manuscript, and is the author responsible for archiving the study files. Neil R. Bhatt had seen the original study data, reviewed the analysis of the data, and approved the final manuscript. Bobby D. Nossaman had seen the original study data, reviewed the analysis of the data, and approved the final manuscript. Scott F. Duncan had seen the original study data, reviewed the analysis of the data, and approved the final manuscript. Matthew E. Patterson had seen the original study data, reviewed the analysis of the data, and approved the final manuscript. Leslie E. Sisco-Wise had seen the original study data, reviewed the analysis of the data, and approved the final manuscript.
Statement of Human and Animal Rights
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Statement of Informed Consent
The requirement for written informed consent was waived by the Institutional Review Board.
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This report describes human research. IRB contact information:
Ochsner Clinic Foundation Institutional Review Board
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The requirement for written informed consent was waived by the Institutional Review Board.
This report describes an observational clinical study.
This report describes a cross-sectional observational study. The author states that the report includes every item in the STROBE checklist for cross-sectional observational studies.
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Soberón, J.R., Bhatt, N.R., Nossaman, B.D. et al. Distal peripheral nerve blockade for patients undergoing hand surgery: a pilot study. HAND 10, 197–204 (2015). https://doi.org/10.1007/s11552-014-9680-4
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DOI: https://doi.org/10.1007/s11552-014-9680-4