A retrospective study of the incidence of neurological injury after axillary brachial plexus block.
BACKGROUND
It has been suggested that performing a nerve block under general anesthesia, as customary in pediatric population, may predispose to nerve injury. However, few clinical data exist to either support or refute this assertion.


METHODS
We retrospectively reviewed data on all patients who received an axillary block for upper extremity surgery in our institution during an eight-year period. The blocks were performed under sedation or general anesthesia, without using a nerve stimulator. Perioperative records from the Hand Surgery Unit Clinic were reviewed for postoperative complaints and complications.


RESULTS
In the eight-year period of the review, 336 patients had axillary block. In total, 230 received the block with sedation and 106 during general anesthesia. All the sedated patients were older than 14 years (mean age 45.2), while of the general anesthesia patients 48 were older than 14 years (mean age 13.9 years). There were six cases of postoperative nerve injury in sedated patients (2.6%) vs. eight cases (7.5%) in the general anesthesia patients. Most patients recovered fully within several weeks. One patient had permanent nerve injury.


CONCLUSIONS
Definitive conclusions cannot be drawn because of disparities in patient group demographics (majority of pediatric patients were in the general anesthesia group) and the retrospective nature of this study. Nevertheless, the findings suggest that the conduct of axillary block under general anesthesia in pediatric patients holds a greater potential for nerve injury than when the block is performed under sedation in adults.
Ben-David
B
B
Department of Anesthesiology, University of Pittsburgh Medical Centers, Shadyside Hospital, Pittsburgh, Pennsylvania, USA.
Barak
M
M
Katz
Y
Y
Stahl
S
S
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D018681:Anesthetics, General / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D001365:Axilla; D001917:Brachial Plexus / Q000293:injuries* / Q000473:pathology / Q000503:physiopathology; D020516:Brachial Plexus Neuropathies / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D015984:Causality; D002648:Child; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies
D018681:Anesthetics, General; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives