Journal of Anesthesia

, Volume 27, Issue 4, pp 611–614 | Cite as

Choice of loco-regional anesthetic technique affects operating room efficiency for carpal tunnel release

  • Edward R. Mariano
  • Megan K. Lehr
  • Vanessa J. Loland
  • Michael L. Bishop
Short Communication

Abstract

Intravenous regional anesthesia (Bier block) is indicated for minor procedures such as carpal tunnel release but must be performed in the operating room. We hypothesize that preoperative peripheral nerve blocks decrease anesthesia-controlled time compared to Bier block for carpal tunnel release. With IRB approval, we reviewed surgical case data from a tertiary care university hospital outpatient surgery center for 1 year. Unilateral carpal tunnel release cases were grouped by anesthetic technique: (1) preoperative nerve blocks, or (2) Bier block. The primary outcome was anesthesia-controlled time (minutes). Secondary outcomes included surgical time and time for nerve block performance in minutes, when applicable. Eighty-nine cases met criteria for analysis (40 nerve block and 49 Bier block). Anesthesia-controlled time [median (10th–90th percentiles)] was shorter for the nerve block group compared to Bier block [11 (6–18) vs. 13 (9–20) min, respectively; p = 0.02). Surgical time was also shorter for the nerve block group vs. the Bier block group [13 (8–21) and 17 (10–29) min, respectively; p < 0.01), but nerve blocks took 10 (5–28) min to perform. Ultrasound-guided nerve blocks performed preoperatively reduce anesthesia-controlled time compared to Bier block and may be a useful anesthetic modality in some practice environments.

Keywords

Ultrasound Anesthesia Conduction Nerve block Bier block Operating room efficiency 

Notes

Acknowledgments

The authors gratefully acknowledge the editorial assistance of Dr. Steven K. Howard, Director of Clinical Research, Anesthesiology and Perioperative Care Service; VA Palo Alto Health Care System.

Conflict of interest

Dr. Mariano has received honoraria for educational programs conducted by SonoSite (Bothell, WA). This company had absolutely no input into any aspect of the present study conceptualization, design, and implementation; data collection, analysis and interpretation; or manuscript preparation. None of the other authors has any personal financial interests to disclose.

References

  1. 1.
    Klein SM, Evans H, Nielsen KC, Tucker MS, Warner DS, Steele SM. Peripheral nerve block techniques for ambulatory surgery. Anesth Analg. 2005;101:1663–76.PubMedCrossRefGoogle Scholar
  2. 2.
    Klein SM, Nielsen KC, Greengrass RA, Warner DS, Martin A, Steele SM. Ambulatory discharge after long-acting peripheral nerve blockade: 2382 blocks with ropivacaine. Anesth Analg. 2002;94:65–70.PubMedGoogle Scholar
  3. 3.
    Mariano ER, Chu LF, Peinado CR, Mazzei WJ. Anesthesia-controlled time and turnover time for ambulatory upper extremity surgery performed with regional versus general anesthesia. J Clin Anesth. 2009;21:253–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Armstrong KP, Cherry RA. Brachial plexus anesthesia compared to general anesthesia when a block room is available. Can J Anaesth. 2004;51:41–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Brill S, Middleton W, Brill G, Fisher A. Bier’s block; 100 years old and still going strong! Acta Anaesthesiol Scand. 2004;48:117–22.PubMedCrossRefGoogle Scholar
  6. 6.
    Gebhard RE, Al-Samsam T, Greger J, Khan A, Chelly JE. Distal nerve blocks at the wrist for outpatient carpal tunnel surgery offer intraoperative cardiovascular stability and reduce discharge time. Anesth Analg. 2002;95:351–5.PubMedGoogle Scholar
  7. 7.
    McCartney CJ, Xu D, Constantinescu C, Abbas S, Chan VW. Ultrasound examination of peripheral nerves in the forearm. Reg Anesth Pain Med. 2007;32:434–9.PubMedGoogle Scholar
  8. 8.
    Gray AT, Schafhalter-Zoppoth I. Ultrasound guidance for ulnar nerve block in the forearm. Reg Anesth Pain Med. 2003;28:335–9.PubMedGoogle Scholar
  9. 9.
    Ponrouch M, Bouic N, Bringuier S, Biboulet P, Choquet O, Kassim M, Bernard N, Capdevila X. Estimation and pharmacodynamic consequences of the minimum effective anesthetic volumes for median and ulnar nerve blocks: a randomized, double-blind, controlled comparison between ultrasound and nerve stimulation guidance. Anesth Analg. 2010;111:1059–64.PubMedGoogle Scholar
  10. 10.
    Neal JM, Brull R, Chan VW, Grant SA, Horn JL, Liu SS, McCartney CJ, Narouze SN, Perlas A, Salinas FV, et al. The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: executive summary. Reg Anesth Pain Med. 2010;35:S1–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Mazzei WJ. Operating room start times and turnover times in a university hospital. J Clin Anesth. 1994;6:405–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Dilger JA, Wells RE Jr. The use of peripheral nerve blocks at the elbow for carpal tunnel release. J Clin Anesth. 2005;17:621–3.PubMedCrossRefGoogle Scholar
  13. 13.
    Macaire P, Singelyn F, Narchi P, Paqueron X. Ultrasound- or nerve stimulation-guided wrist blocks for carpal tunnel release: a randomized prospective comparative study. Reg Anesth Pain Med. 2008;33:363–8.PubMedGoogle Scholar
  14. 14.
    Macaire P, Choquet O, Jochum D, Travers V, Capdevila X. Nerve blocks at the wrist for carpal tunnel release revisited: the use of sensory-nerve and motor-nerve stimulation techniques. Reg Anesth Pain Med. 2005;30:536–40.PubMedGoogle Scholar
  15. 15.
    Delaunay L, Chelly JE. Blocks at the wrist provide effective anesthesia for carpal tunnel release. Can J Anaesth. 2001;48:656–60.PubMedCrossRefGoogle Scholar
  16. 16.
    Dexter F, Coffin S, Tinker JH. Decreases in anesthesia-controlled time cannot permit one additional surgical operation to be reliably scheduled during the workday. Anesth Analg. 1995;81:1263–8.PubMedGoogle Scholar
  17. 17.
    Oldman M, McCartney CJ, Leung A, Rawson R, Perlas A, Gadsden J, Chan VW. A survey of orthopedic surgeons’ attitudes and knowledge regarding regional anesthesia. Anesth Analg. 2004;98:1486–90.PubMedCrossRefGoogle Scholar
  18. 18.
    Mariano ER. Making it work: setting up a regional anesthesia program that provides value. Anesthesiol Clin. 2008;26:681–92, vi.Google Scholar
  19. 19.
    Ahmed SU, Vallejo R, Hord ED. Seizures after a Bier block with clonidine and lidocaine. Anesth Analg. 2004;99:593–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Ananthanarayan C, Castro C, McKee N, Sakotic G. Compartment syndrome following intravenous regional anesthesia. Can J Anaesth. 2000;47:1094–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Guay J. Adverse events associated with intravenous regional anesthesia (Bier block): a systematic review of complications. J Clin Anesth. 2009;21:585–94.PubMedCrossRefGoogle Scholar
  22. 22.
    Luce EA, Mangubat E. Loss of hand and forearm following Bier block: a case report. J Hand Surg Am. 1983;8:280–3.PubMedCrossRefGoogle Scholar
  23. 23.
    Derkash RS, Weaver JK, Berkeley ME, Dawson D. Office carpal tunnel release with wrist block and wrist tourniquet. Orthopedics. 1996;19:589–90.PubMedGoogle Scholar
  24. 24.
    Liebmann O, Price D, Mills C, Gardner R, Wang R, Wilson S, Gray A. Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department. Ann Emerg Med. 2006;48:558–62.PubMedCrossRefGoogle Scholar
  25. 25.
    Eichenberger U, Stockli S, Marhofer P, Huber G, Willimann P, Kettner SC, Pleiner J, Curatolo M, Kapral S. Minimal local anesthetic volume for peripheral nerve block: a new ultrasound-guided, nerve dimension-based method. Reg Anesth Pain Med. 2009;34:242–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Tomaino MM, Ulizio D, Vogt MT. Carpal tunnel release under intravenous regional or local infiltration anaesthesia. J Hand Surg Br. 2001;26:67–8.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists(outside the USA) 2013

Authors and Affiliations

  • Edward R. Mariano
    • 1
    • 2
  • Megan K. Lehr
    • 3
  • Vanessa J. Loland
    • 4
  • Michael L. Bishop
    • 5
  1. 1.Department of Anesthesia, Anesthesiology and Perioperative Care ServiceVA Palo Alto Health Care SystemPalo AltoUSA
  2. 2.Stanford University School of MedicineStanfordUSA
  3. 3.United States Air ForceBiloxiUSA
  4. 4.Department of Anesthesiology and Pain MedicineUniversity of WashingtonSeattleUSA
  5. 5.Department of AnesthesiologyUniversity of CaliforniaSan DiegoUSA

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