Radial or brachial artery injections for intraarterial regional anesthesia for hand surgery?
OBJECTIVE
The aim of this study was to determine the optimal injection site for the intraarterial regional anesthesia for hand surgery.


METHODS
Forty-two adult patients undergoing elective hand surgery were studied. 0.5% lidocaine plain 1.5 mg/kg was injected over 3 minutes into the radial artery (group 1), or the brachial artery (group 2) through a 22 or 20 gauge Teflon catheter.


RESULTS
Two patients (one in each group) were excluded due to technical problems. Onset of analgesia in the hand was faster after radial artery injection (P < .05). Onset of analgesia in the forearm was similar in both groups. Catheterization time, operating conditions, motor block, offset of analgesia, injection, surgical and tourniquet pain scores, and patient's acceptance were similar. Ten patients in group 1 and nine patients in group 2 needed supplemental analgesia at the start of surgery. Median nerve paresthesias were unintentionally elicited during catheterization in three patients in group 2. Six patients (two in group 1 and four in group 2) had minor systemic adverse effects after tourniquet release. Seven patients in group 1 and five in group 2 developed minor bruises after catheterization. No permanent sequelae of injections were observed.


CONCLUSIONS
Radial artery is preferred for intraarterial regional anesthesia. Compared with the brachial artery, injection in the radial artery produces faster analgesia in the hand and reduces the risk of damage to the median nerve.
Koscielniak-Nielsen
Z J
ZJ
Department of Anesthesia, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
Horn
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000698:Analgesia; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000379:methods*; D001916:Brachial Artery; D017558:Elective Surgical Procedures; D005260:Female; D005542:Forearm / Q000294:innervation; D006225:Hand / Q000294:innervation / Q000601:surgery*; D006801:Humans; D007269:Injections, Intra-Arterial / Q000009:adverse effects; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008475:Median Nerve / Q000187:drug effects; D008875:Middle Aged; D009046:Motor Neurons / Q000187:drug effects; D010292:Paresthesia / Q000139:chemically induced; D017060:Patient Satisfaction; D017534:Radial Artery; D011826:Radial Nerve / Q000187:drug effects; D013997:Time Factors; D014111:Tourniquets / Q000009:adverse effects; D014459:Ulnar Nerve / Q000187:drug effects
D008012:Lidocaine