title: [Operative management in axillary brachial plexus blocks: comparison of ultrasound and nerve stimulation].
abstract: Given a case-by-case accounting system, the analysis of medical performance becomes increasingly important. Quality of treatment and the time effort attached play an important role. Anaesthesia procedures require a high level of quality and safety. Moreover, they are personnel intensive. In the area of regional anaesthesia, new procedures such as the use of high definition ultrasonography for nerve blocks, allow a possible time gain as well as improved quality. The aim of this investigation was to analyze the impact on time and results when using ultrasonography or nerve stimulation for axillary brachial plexus blocks. Therefore, over a time period of 9 months, the ultrasound-guided plexus anaesthesia (Sono) and the neurostimulation methods (NStim) were investigated based upon the anaesthesia documentation of patients undergoing hand surgery. Only those cases were included where an axillary brachial plexus block had been performed, incomplete protocols were excluded and 1.5% mepivacaine was used as medication. Overall, a total of 130 cases fulfilled these criteria. The success rates, time consumption and timelines were evaluated. All data was stored on an Excel-sheet and statistically evaluated. The results revealed a significant increase in the success rate for the patient group where ultrasound was used (98.2% Sono vs 83.1% NStim) and the operation could begin 15 min earlier in the Sono group (5 min vs. 20 min, p<0.001). Furthermore, the duration of anaesthesia was significantly shorter (85 min vs. 120 min, p<0.001) and the necessity for post-operative observation was less (5.4% vs. 32.4%, p<0.001). The data provided in the study indicate that the use of ultrasound for the identification of the nerves can clearly improve quality and time-scales of axillary brachial plexus blocks.
authors.affiliation: Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Germany. schwemmer_u@klinik.uni-wuerzburg.de
authors.forename: U
authors.initials: U
authors.lastname: Schwemmer
authors.forename: A
authors.initials: A
authors.lastname: Schleppers
authors.forename: C
authors.initials: C
authors.lastname: Markus
authors.forename: M
authors.initials: M
authors.lastname: Kredel
authors.forename: S
authors.initials: S
authors.lastname: Kirschner
authors.forename: N
authors.initials: N
authors.lastname: Roewer
mesh_terms: D000328:Adult; D000765:Anesthesia, Conduction; D000779:Anesthetics, Local; D001365:Axilla / Q000000981:diagnostic imaging*; D015992:Body Mass Index; D001917:Brachial Plexus / Q000000981:diagnostic imaging*; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008619:Mepivacaine; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000779:Anesthetics, Local; D008619:Mepivacaine